| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | HARTFORD LIFE AND ACCIDENT | — | $42K | $42K | 5.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON STE14B CHICAGO, IL 60604 | HARTFORD FIRE INSURANCE COMPANY | — | $95 | $95 | 4.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $1.2M |
| RXBENEFITS, INC. EIN 63-1157085 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $16K |
| THE HARTFORD EIN 06-0383750 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | ONE HARTFORD PLAZA HARTFORD, CT 06155 | $12K |
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 | 1,438 | 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) | 1,451 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HAWAII MEDICAL SERVICE ASSOCIATION | 19 | $125K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF ARIZONA | 2,431 | $1.4M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 873 | $335K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,390 | $913K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,390 | $788K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,390 | $788K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 1,390 | $814K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,431 | — |
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.