| 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 | $25K | $1K | $26K | 8.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | PRUDENTIAL INSURANCE COMPANY | $32K | — | $32K | 13.68% |
| COMPSYCH3 | 455 N CITYFRONT PLAZA DR, 13TH FL CHICAGO, IL 60611 | PRUDENTIAL INSURANCE COMPANY | — | $3K | $3K | 1.38% |
| IMG3 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY | — | $82 | $82 | 0.03% |
| 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 | $905 | $5K | 11.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | P.O. BOX 853921 RICHARDSON, TX 75085 | $402K |
| BSI ADMINISTRATIVE SERVICES EIN 13-3623331 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $101K |
| 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 |
| JACKSON LEWIS PC LAWYER | Legal Service code 29 | 7101 COLLEGE BLVD., SUITE 1200 OVERLAND, KS 66210 | $9K |
| DUDEK EIN 95-3873865 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $0 |
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 | 525 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 531 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 22 | $135K |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 342 | $446K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 281 | $180K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY | 457 | $235K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY | 457 | $235K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY | 457 | $235K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 22 | $135K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 435 | $1.1M |
| Other | PRUDENTIAL INSURANCE COMPANY | 457 | $235K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 457 | — |
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.