| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | KAISER FOUNDATION HEALTH PLAN INC | $9K | — | $9K | 5.35% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 425 CALIFORNIA ST STE 2400 SAN FRANCISCO, CA 941042215 | KAISER FOUNDATION HEALTH PLAN INC | $1K | — | $1K | 0.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 3635 RIVERSIDE PLAZA DR SUITE 300 RIVERSIDE, CA 92506 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 6.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | HUB INTERNATIONAL MIDWEST LIMITED RIVERSIDE, CA 925162158 | EYEMED VISION CARE | $1K | — | $1K | 5.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $1K | — | $1K | 4.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARTMENT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $309 | — | $309 | 22.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | EMPLOYEE BENEFITS DEPARTMENT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $227 | — | $227 | 19.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | HUB INTERNATIONAL MIDWEST LIMITED RIVERSIDE, CA 925162158 | EYEMED VISION CARE | $42 | — | $42 | 6.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 806044466 | EYEMED VISION CARE | $37 | — | $37 | 5.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTHCARE SERVICE INC EIN 41-1289245 CLAIM PROCESSOR | Claims processing; Other services Service code 12 | — | $96K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 ADVICE SERVICES | Other services Service code 49 | — | $7K |
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 | 249 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 17 | $172K |
| Vision(2 contracts) | EYEMED VISION CARE | 353 | $24K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 249 | $26K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 92 | $42K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 334 | $762K |
| Other(10 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 249 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 353 | — |
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.