| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD FL 14 CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $19K | $45 | $19K | 4.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER DR 40 W MADISON 4TH FL BANK OF AMERICA CHICAGO, IN 606930162 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 0.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | RELIASTAR LIFE INSURANCE COMPANY | $12K | — | $12K | 34.86% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS ADMIN., INC | 101 S GARLAND AVE STE 203 ORLANDO, FL 328013277 | RELIASTAR LIFE INSURANCE COMPANY | — | $805 | $805 | 2.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $211K |
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 | 886 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 890 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 100 | $502K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 1,559 | $438K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,559 | $438K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY HARTFORD CT | 536 | $295K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,559 | $472K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,559 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.