| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 200 CROSSINGS BOULEVARD WARWICK, RI 02886 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $384K | $384K | 2.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 200 CROSSINGS BOULEVARD WARWICK, RI 02886 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $48K | $0 | $48K | 6.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 2.40% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $142 | $0 | $142 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 2.51% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $140 | $0 | $140 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 2.96% |
| BSI CORPORATE BENEFITS LLC3 | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $144 | $0 | $144 | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 4.70% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $121 | $0 | $121 | 0.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 4.98% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS, LLC | 205 WEBSTER ST BETHLEHEM, PA 18015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $264 | $0 | $264 | 0.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BLVD WOODBURY, NY 11797 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $7K | $0 | $7K | 8.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BLVD WOODBURY, NY 11797 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | $0 | $6K | 8.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BLVD WOODBURY, NY 11797 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | $0 | $6K | 8.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 ADMIN | Claims processing Service code 12 | — | $384K |
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 | 1,283 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,290 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,280 | $15.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,473 | $753K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,473 | $753K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,890 | $100K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,890 | $477K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,890 | $112K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,280 | $15.4M |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,890 | $572K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,890 | — |
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.