| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NFP INSURANCE SERVICES INC3 Filed as: NFP CORPORATE SERVICE NY LLC | 340 MADISON AVE 21ST FLOOR NEW YORK, NY 10173 | SUNLIFE ASSURANCE COMPANY OF CANADA | $45K | $0 | $45K | 5.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL MIDWEST LIMITED | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | HARTFORD LIFE AND ACCIDENT | $47K | $3K | $51K | 12.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON CHICAGO, IL 60604 | EYEMED VISION CARE | $6K | $0 | $6K | 7.44% |
| LAURUS STRATEGIES3 | 55 WEST MONROE STE 500 CHICAGO, IL 60603 | EYEMED VISION CARE | $2K | $0 | $2K | 2.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL MIDWEST LIMITED | 16219 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | HARTFORD LIFE AND ACCIDENT | $8K | $361 | $8K | 15.70% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATOR | Non-monetary compensation; Named fiduciary; Participant communication; Float revenue; Direct payment from the plan; Contract Administrator; Other services; Claims processing Service code 12 | — | $504K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $40K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $27K |
| THE HARTFORD EIN 06-0838648 ADMINISTRATOR | Other services Service code 49 | — | $13K |
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 | 1,149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE | 1,602 | $87K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,149 | $410K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,149 | $410K |
| Stop-loss / reinsurancereinsurance | SUNLIFE ASSURANCE COMPANY OF CANADA | 777 | $835K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,156 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,602 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.