| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STHEALTH BENEFIT SOLUTIONS LLC3 | DBA STEALTH PARTNER GROUP 1890 N PIMA RD STE 210 SCOTTSDALE, AZ 85255 | SUN LIFE ASSURANCE COMPANY OF CANADA | $40K | $0 | $40K | 5.00% |
| FST ASSOCIATES INC3 | DBA LAURUS STRATEGIES 55 W MONROE ST STE 500 CHICAGO, IL 60603 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $28K | $28K | 3.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL MIDWEST LIMITED | 55 EAST JACKSON BLVD CHICAGO, IL 60604 | HARTFORD LIFE AND ACCIDENT | $14K | $0 | $14K | 3.32% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | HARTFORD LIFE AND ACCIDENT | $0 | $752 | $752 | 0.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 375 BISHOPS WAY STE 224 BROOKFIELD, WI 53005 | UNITEDHEALTHCARE INSURANCE COMPANY | $8K | $0 | $8K | 9.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF INDIANA LTD | PO BOX 158 EVANSVILLE, IN 47701 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $5K | $5K | 5.78% |
| FST ASSOCIATES INC3 | 950 CORPORATE DR STE 150 MILFORD, MI 48381 | UNITEDHEALTHCARE INSURANCE COMPANY | $683 | $0 | $683 | 0.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 WEST MONROE SUITE 500 CHICAGO, IL 60603 | HM LIFE INSURANCE COMPANY | $2K | — | $2K | 7.29% |
| GROUP INS SERV INC3 | BC BS OF TN ATTN GIS 1 CAMERON HILL CIRCLE CHATTANOOGA, TN 37402 | HM LIFE INSURANCE COMPANY | $2K | — | $2K | 7.00% |
| FST ASSOCIATES INC3 Filed as: FST ASSOCIATES INC. DBA LAURUS STRA | 55 W MONROE SUITE 500 CHICAGO, IL 60603 | HM LIFE INSURANCE COMPANY | $698 | — | $698 | 2.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMINISTRATOR | Named fiduciary; Direct payment from the plan; Participant communication; Other services; Float revenue; Contract Administrator; Non-monetary compensation; Claims processing Service code 12 | — | $618K |
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 CONTRACT ADMINSTRATORS | Contract Administrator Service code 13 | — | $576K |
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 | 1,179 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,185 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,407 | $880K |
| Dental | TRIPLE-S SALUD, INC. | 17 | $77K |
| Vision(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,294 | $116K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,360 | $410K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,360 | $410K |
| Prescription drug | TRIPLE-S SALUD, INC. | 17 | $77K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,407 | $803K |
| Other | HARTFORD LIFE AND ACCIDENT | 1,360 | $410K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,407 | — |
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.