| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 3390 UNIVERSITY AVE., SUITE 300 RIVERSIDE, CA 92501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $22K | — | $22K | 7.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | $1K | $22K | 22.81% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | DEPT LA 23940 PASADENA, CA 91185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $393 | $2K | 1.77% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $867 | $9K | 12.46% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | DEPT LA 23940 PASADENA, CA 91185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $901 | $272 | $1K | 1.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | P.O. BOX 4047 CONCORD, CA 94524 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $4K | $916 | $5K | 12.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 26.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 18.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 18.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $171 | $2K | 12.70% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | DEPT LA 23940 PASADENA, CA 91185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $188 | $57 | $245 | 1.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $116 | $1K | 12.49% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | DEPT LA 23940 PASADENA, CA 91185 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $110 | $32 | $142 | 1.35% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | P.O. BOX 853921 RICHARDSON, TX 75085 | $385K |
| BSI ADMINISTRATIVE SERVICES EIN 13-3623331 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $86K |
| HEALTH JOY ADMINISTRATION | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 215 W SUPERIOR ST 5TH FLOOR CHICAGO, IL 60654 | $37K |
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 | 479 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 481 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 22 | $107K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 295 | $387K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 229 | $146K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 479 | $74K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 50 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 479 | $95K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 22 | $107K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 394 | $978K |
| Other(4 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 497 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 497 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.