| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $40K | $40K | 5.17% |
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH BENEFIT SOLUTIONS LLC DBA | STEALTH PARTNER GROUP 181940 N PIMA RD SUITE 210 SCOTTSDALE, AZ 85255 | SUN LIFE ASSURANCE COMPANY OF CANADA | $35K | — | $35K | 4.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $25K | $7K | $32K | 5.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $11K | $3K | $13K | 5.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 606930001 | VISION SERVICE PLAN | $7K | — | $7K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $9K | $3K | $12K | 5.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | ALPHA DENTAL OF ARIZONA, INC. | $1K | — | $1K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $2K | — | $2K | 4.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Contract Administrator Service code 13 | — | $963K |
| DELTA DENTAL OF ARIZONA EIN 86-0274899 NONE | Claims processing; Contract Administrator Service code 12 | — | $55K |
| LIBERTY LIFE ASSURANCE COMPANY EIN 04-6076039 NONE | Contract Administrator; Claims processing; Insurance services Service code 12 | — | $14K |
| HUB INTERNATIONAL MIDWEST LIMITED NONE | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $11K |
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 | 2,250 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 271 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 205 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,726 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 443 | $2.5M |
| Dental | ALPHA DENTAL OF ARIZONA, INC. | 303 | $65K |
| Vision | VISION SERVICE PLAN | 1,276 | $224K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,921 | $602K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 846 | $212K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,152 | $1.0M |
| Other(2 contracts) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,921 | $640K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,921 | — |
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.