| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 3135 ALBUQUERQUE, NM 871903135 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $17K | — | $17K | 11.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 6565 AMERICAS PKWY NE STE 720 ALBUQUERQUE, NM 87110 | UNITED CONCORDIA INSURANCE COMPANY | $3K | $14 | $3K | 10.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 2158 RIVERSIDE, CA 925162158 | VISION SERVICE PLAN | $790 | — | $790 | 7.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3390 UNIVERSITY AVE, STE 300 RIVERSIDE, CA 92501 | SUN LIFE ASSURANCE COMPANY OF CANADA | $871 | — | $871 | 15.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 2560 PROFESSIONAL PKWY SANTA MONICA, CA 93455 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $82 | $82 | 1.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INS. COMPANY EIN 59-1031071 NONE | Participant communication; Contract Administrator; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation Service code 12 | — | $16K |
| CIGNA | Claims processing; Direct payment from the plan; Float revenue; Named fiduciary; Other services; Non-monetary compensation; Contract Administrator; 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 | 45 | 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) | 45 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 83 | $146K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 103 | $34K |
| Vision | VISION SERVICE PLAN | 78 | $11K |
| Life insurance(2 contracts, 2 carriers) | KANSAS CITY LIFE INSURANCE COMPANY | 45 | $24K |
| Short-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 45 | $18K |
| Long-term disability | KANSAS CITY LIFE INSURANCE COMPANY | 45 | $18K |
| Other(3 contracts, 3 carriers) | KANSAS CITY LIFE INSURANCE COMPANY | 45 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 103 | — |
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.