| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWST LIMITED | SUITE 300 3635 RIVERSIDE PLAZA DR RIVERSIDE, CA 92506 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $27K | — | $27K | 74.19% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $343 | $343 | 0.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 500 COUNTRY PINE LANE BATTLE CREEK, MI 490154177 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6 | — | $6 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON, SUITE 1200 CHICAGO, IL 60604 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $303 | — | $303 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Contract Administrator Service code 13 | — | $808K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 NONE | Claims processing; Contract Administrator Service code 12 | — | $31K |
| RX BENEFITS, INC. EIN 63-1157085 NONE | Claims processing Service code 12 | — | $10K |
| COMPSYCH EIN 35-3739783 NONE | 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 | 979 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 992 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF ARIZONA | 793 | $830K |
| Vision | VISION SERVICE PLAN | 592 | $149K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 973 | $36K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 973 | $193K |
| Other(11 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,087 | $370K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,087 | — |
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."
No prospect flags tripped on this filing.