| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | UNITEDHEALTHCARE INSURANCE COMPANY | $31K | $0 | $31K | 2.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 3635 RIVERSIDE PLACE DRIVE BUILDING M3 RIVERSIDE, CA 92506 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $2K | $2K | 0.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $7K | $18K | 20.31% |
| PLANSOURCE BENEFIT ADMINISTRATION5 Filed as: PLANSOURCE BENEFIT ADMINISRATION | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 7770 JEFFERSON STREET NE, SUITE 101 ALBUQUERQUE, NM 87109 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $54 | $4K | 7.08% |
| BETA HEALTH ASSOCIATION3 Filed as: BETA HEALTH ASSOCIATION INC. | 6200 SOUTH SYRACUSE WAY, SUITE 460 GREENWOOD VILLAGE, CO 80111 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $0 | $4K | 6.97% |
| INS EXCHANGE LLC3 | 5 ROEHM COURT WEST ORANGE, NJ 07052 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 2.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $294 | $294 | 0.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 844663 DALLAS, TX 75284 | VISION SERVICE PLAN | $853 | $0 | $853 | 6.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | BETA HEALTH | $795 | $0 | $795 | 7.60% |
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 | 139 | 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) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 244 | $1.2M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 171 | $62K |
| Vision | VISION SERVICE PLAN | 82 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $89K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $89K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $89K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 244 | $1.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 139 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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.