| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | KAISER FOUNDATION HEALTH PLAN INC | $30K | — | $30K | 1.80% |
| NICHOLAS THOMAS GIALAMAS3 | 580 N BANK LN LAKE FOREST, IL 60045 | HEALTH NET | $4K | — | $4K | 1.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD 14TH FL CHICAGO, IL 60604 | HEALTH NET | $1K | — | $1K | 0.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST WEST | 55 E JACKSON BLVD. CHICAGO, IL 60604 | DELTA DENTAL OF ILLINOIS | $2K | — | $2K | 9.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATOR | Named fiduciary; Contract Administrator; Direct payment from the plan; Float revenue; Non-monetary compensation; Claims processing; Participant communication; Other services Service code 12 | — | $67K |
| CIGN | Contract Administrator; Non-monetary compensation; Other services; Direct payment from the plan; Claims processing; Named fiduciary; Participant communication; Float revenue Service code 12 | — | $0 |
| CIGNA | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $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 | 2,682 | 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) | 2,682 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,944 | $2.1M |
| Dental | DELTA DENTAL OF ILLINOIS | 1,916 | $17K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 695 | $216K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 2,682 | $33K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 2,682 | $33K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 2,682 | $33K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 695 | $216K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 2,682 | $33K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,682 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.