| 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 | $27K | — | $27K | 7.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 1525 FARADAY AVE., SUITE 200 CARLSBAD, CA 92008 | PRUDENTIAL INSURANCE COMPANY | $41K | $15K | $57K | 18.11% |
| COMPSYCH3 | 455 N CITYFRONT PLAZA DR, 13TH FL CHICAGO, IL 60611 | PRUDENTIAL INSURANCE COMPANY | — | $5K | $5K | 1.51% |
| IMG3 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY | — | $119 | $119 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 4047 CONCORD, CA 94524 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $5K | $1K | $6K | 11.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | P.O. BOX 853921 RICHARDSON, TX 75085 | $629K |
| BENEFIT SOURCE INC EIN 57-0556933 CONTRACT ADMIN./TRUSTEE | Contract Administrator; Trustee (bank, trust company, or similar financial institution) Service code 13 | 304 RIDGELAND DRIVE GREENVILLE, SC 29601 | $91K |
| HEALTHJOY ADMINISTRATION | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 215 W SUPERIOR, 5TH FLOOR CHICAGO, IL 60654 | $73K |
| PRUDENTIAL INS. CO. OF AMERICA EIN 22-1211670 ADMINISTRATION | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $22K |
| PARETOHEALTH ADMINISTRATION | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | FMC TOWER, STE. 1500 2929 WALNUT STREET PHILADELPHIA, PA 19104 | $10K |
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 | 589 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 593 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERSITY HEALTH ALLIANCE | 25 | $0 |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 380 | $345K |
| Vision(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 311 | $54K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY | 589 | $312K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY | 589 | $312K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY | 589 | $312K |
| Prescription drug | UNIVERSITY HEALTH ALLIANCE | 25 | $0 |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 462 | $1.5M |
| Other | PRUDENTIAL INSURANCE COMPANY | 589 | $312K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 589 | — |
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.