| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 9200 WARD PARKWAY, SUITE 500 KANSAS CITY, MO 64114 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $79K | $79K | 3.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDSWEST LIMITED | 9200 WARD PARKWAY, SUITE 500 KANSAS CITY, MO 64114 | PRINCIPAL LIFE INSURANCE COMPANY | $12K | $0 | $12K | 8.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 150 NORTH RIVERSIDE PLAZA SUITE 1700 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $4K | $4K | 3.11% |
| CENTRO BENEFITS RESEARCH LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $4K | $4K | 3.04% |
| SBR SERVICES LLC3 | 2300 WINDY RIDGE PARKWAY SE SUITE 6 ATLANTA, GA 30339 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 6100 SOUTH YALE AVENUE, SUITE 1900 TULSA, OK 74136 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $3K | $17K | 16.81% |
| SBR SERVICES LLC3 | 2300 WINDY RIDGE PARKWAY SE SUITE 695 ATLANTA, GA 30339 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 2.98% |
No Schedule C service providers reported on this filing.
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 | 175 | 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) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 150 | $2.2M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 306 | $142K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 306 | $142K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $99K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $99K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $99K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 150 | $2.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 175 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 306 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.