| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $109K | — | $109K | 11.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $4K | — | $4K | 2.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | — | $9K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 4.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD FL 1 CHICAGO, IL 60604 | SUN LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 9.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | EYEMED VISION CARE | $50 | — | $50 | 2.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 ADMINISTRATIVE SERVICES | Non-monetary compensation; Other services; Participant communication; Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Named fiduciary Service code 12 | — | $713K |
| CIGNA | Other services; Non-monetary compensation; Claims processing; Direct payment from the plan; Float revenue; Named fiduciary; Participant communication; Contract Administrator 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 | 1,546 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,558 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMSA HEALTH PLAN | 302 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,299 | $44K |
| Vision(2 contracts) | EYEMED VISION CARE | 2,566 | $129K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,673 | $983K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 229 | $59K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,673 | $983K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,673 | $998K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,566 | — |
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.