| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VIRTUS LLC3 | 9800 METCALF AVE SUITE 500 OVERLAND PARK, KS 66212 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $26K | $26K | 4.37% |
| VIRTUS LLC3 | 9800 METCALF AVE., STE. 500 OVERLAND PARK, KS 662122286 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $44 | $4K | 7.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | $601 | — | $601 | 0.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 40 W MADISON 4TH FL BANK OF AMERICA 16253 COLLECTIONS CENTER DR CHICAGO, IL 606930162 | METROPOLITAN LIFE INSURANCE COMPANY | — | $150 | $150 | 0.24% |
| VIRTUS LLC3 | 2020 W 89TH STREET, SUITE 200 LEAWOOD, KS 66206 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $637 | — | $637 | 3.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $192 | — | $192 | 0.93% |
| VIRTUS LLC3 | 2020 W 89TH STREET SUITE 200 LEAWOOD, KS 66206 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $422 | — | $422 | 2.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $144 | — | $144 | 1.02% |
| VIRTUS LLC3 | 2020 W 89TH STREET, SUITE 200 LEAWOOD, KS 66206 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $406 | — | $406 | 2.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $153 | — | $153 | 1.10% |
| VIRTUS LLC3 | 2020 W 89TH STEET SUITE 200 LEAWOOD, KS 66206 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $77 | — | $77 | 3.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15 | — | $15 | 0.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $41K |
| SURENCY LIFE & HEALTH INSURANCE EIN 26-1969006 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $2K |
| CIGNA HEALTH & LIFE INSURANCE CO. | Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Named fiduciary; Contract Administrator; Float revenue; Participant communication 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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 94 | $592K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 342 | $62K |
| Vision | VISION SERVICE PLAN | 91 | $9K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $21K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $14K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $14K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 94 | $592K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 121 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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.