| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 3510 N CAUSEWAY BLVD STE 200 METAIRIE, LA 70002 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $21K | — | $21K | 62.20% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE., STE. 1100 CHICAGO, IL 606036115 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | — | $320 | $320 | 0.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 500 COUNTRY PINE LANE BATTLE CREEK, MI 490154177 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $7 | — | $7 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $697K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $32K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Claims processing Service code 12 | — | $10K |
| COMPSYCH EIN 35-3739783 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $2K |
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 | 938 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 939 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ARIZONA | 766 | $767K |
| Vision | VISION SERVICE PLAN | 578 | $134K |
| Life insurance | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 936 | $33K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,040 | $177K |
| Other(9 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,040 | $322K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,040 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.