| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED1 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $109K | $19K | $128K | 11.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $46K | $8K | $55K | 11.75% |
| BRADAWN INSURANCE SERVICES, INC.3 | 500 LA TERRAZA BLVD SUITE 102 ESCONDIDO, CA 92025 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $199 | — | $199 | 9.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP, LLC EIN 77-0385729 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $968K |
| BLUE CROSS EIN 95-4331852 PPO/UR VENDOR | Direct payment from the plan; Other fees Service code 50 | — | $953K |
| ANTHEM BLUE CROSS AND HEALTH INS EIN 95-4331852 CONTRACT ADMINISTRATOR | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Non-monetary compensation Service code 12 | — | $703K |
| HUB INTERNATIONAL MIDWEST LTD EIN 35-0672425 BROKER | Insurance agents and brokers; Other commissions; Direct payment from the plan; Non-monetary compensation Service code 22 | — | $125K |
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 N/A | Contract Administrator; Claims processing Service code 12 | — | $82K |
| RXBENEFITS, INC. EIN 63-1157085 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $38K |
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 | 2,746 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,763 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 2,700 | $0 |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,788 | $1.1M |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,788 | $1.1M |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,788 | $1.1M |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,900 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,900 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.