| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 75 WEST TOWNE RIDGE PARKWAY SUITE 400, TOWER 2 SANDY, UT 84070 | UNITEDHEALTHCARE INSURANCE COMPANY | $26K | $142K | $168K | 4.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PLACE, SUITE 450 DOWNERS GROVE, IL 60515 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $16K | $16K | 0.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 75 WEST TOWNE RIDGE PARKWAY SUITE 400, TOWER 2 SANDY, UT 84070 | LIFEMAP ASSURANCE COMPANY | $25K | $0 | $25K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | UNKNOWN SALT LAKE CITY, UT 84101 | UPMC HEALTH OPTIONS | $6K | $0 | $6K | 2.95% |
| CUSTOM INSURANCE SPECIALISTS INC3 | 886 EAST 3200 NORTH KAMAS, UT 84036 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $178 | $4K | 13.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 6.94% |
| LISA B NIELSEN3 Filed as: LISA B. NIELSEN | PO BOX 703 VERNAL, UT 84078 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $451 | $0 | $451 | 1.50% |
| LESLEE BROOKE GOBELMAN3 Filed as: LESLEE B. GOBELMAN AND OTHER AGENTS | 5607 SOUTH GREENLEAF DRIVE MURRAY, UT 84123 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $421 | $0 | $421 | 1.40% |
| JILL HUGHES3 Filed as: JILL HUGHS | 6510 SOUTH TAMRA DRIVE TAYLORSVILLE, UT 84129 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $254 | $11 | $265 | 0.88% |
No Schedule C service providers reported on this filing.
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 | 216 | 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) | 229 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 995 | $4.2M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 995 | $3.9M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 995 | $3.9M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 216 | $246K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 216 | $246K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 216 | $246K |
| Prescription drug(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 995 | $4.2M |
| Other(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 216 | $276K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 995 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.