| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD 14TH FL CHICAGO, IL 60604 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $48K | $48K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD 14TH FL CHICAGO, IL 60604 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $747 | $747 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD FL 14 CHICAGO, IL 606044466 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $55 | $11K | 9.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 40 W MADISON 4TH FL BANK OF AMERICA 16253 COLLECTION CENTER DRIVE CHICAGO, IL 606930162 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $866 | — | $866 | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $766 | — | $766 | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 15162 COLLECTIONS CENTER CHICAGO, IL 60693 | LIFE INSURANCE COMPANY OF AMERICA | $195 | — | $195 | 3.55% |
| VIRTUS LLC3 | 2020 W 89TH STREET, SUITE 200 LEAWOOD, KS 66206 | LIFE INSURANCE COMPANY OF AMERICA | $25 | — | $25 | 0.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD 14TH FL STE 14A CHICAGO, IL 60604 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $32 | — | $32 | 9.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Contract Administrator Service code 13 | — | $48K |
| SURENCY LIFE & HEALTH INSURANCE EIN 26-1969006 NONE | Plan Administrator Service code 14 | — | $3K |
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 | 141 | 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) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 176 | $957K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 425 | $108K |
| Vision | VISION SERVICE PLAN | 106 | $12K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 181 | $19K |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 141 | $52K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 141 | $22K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 176 | $957K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 181 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 425 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.