| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC | 1125 17TH STREET SUITE 900 DENVER, CO 80202 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $5K | $15K | 18.61% |
| PLANSOURCE BENEFITS ADMINISTRATION5 Filed as: PLANSOURCE BENEFITS ADMIN. INC. | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 2.54% |
| PLANSOURCE BENEFITS ADMINISTRATION5 Filed as: PLANSOURCE BENEFIT ADMIN. INC. | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $696 | $696 | 0.85% |
| BETA HEALTH ASSOCIATION3 Filed as: BETA HEALTH ASSOCIATION, INC. | 6200 SOUTH SYRACUSE WAY SUITE 460 GREENWOOD VILLAGE, CO 80111 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $720 | $4K | 7.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC | 7770 JEFFERSON STREET NE, SUITE 101 ALBUQUERQUE, NM 87109 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $55 | $3K | 6.52% |
| INS EXCHANGE LLC3 Filed as: INS EXHCANGE LLC | 5 ROEHM COURT WEST ORANGE, NJ 07052 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $459 | $2K | 3.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $372 | $372 | 0.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC | PO BOX 844663 DALLAS, TX 75284 | VISION SERVICE PLAN | $799 | $0 | $799 | 7.03% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 126 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 230 | $971K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 177 | $61K |
| Vision | VISION SERVICE PLAN | 71 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $82K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $82K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $82K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 230 | $971K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 126 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.