| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURTON CONSULTING3 Filed as: BURTON CONSULTING DBA LAU | 55 W MONROE STE 500 CHICAGO, IL 60603 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $35K | $35K | 3.37% |
| FST ASSOCIATES INC3 Filed as: FST ASSOCIATES, INC. | 55 W MONROE SUITE 500 CHICAGO, IL 60603 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $9K | — | $9K | 1.26% |
| FST ASSOCIATES INC3 Filed as: FST ASSOCIATES | 55 WEST MONROE ST STE 500 CHICAGO, IL 60603 | METROPOLITAN LIFE INSURANCE COMPANY | $24K | $8K | $32K | 6.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 55 E JACKSON BLVD SUITE 1400 CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | — | $11K | 2.08% |
| LAURUS STRATEGIES3 | 55 W MONROE SUITE 500 CHICAGO, IL 60603 | EYEMED VISION CARE | $25K | — | $25K | 5.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON CHICAGO, IL 60604 | EYEMED VISION CARE | $13K | — | $13K | 3.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON CHICAGO, IL 60604 | EYEMED VISION CARE | $307 | — | $307 | 3.39% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTH CARE EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $2.9M |
| CIGNA HEALTH & LIFE INSURANCE EIN 59-1031071 FMLA PLAN ADMINISTRATOR | Participant communication; Direct payment from the plan; Non-monetary compensation; Claims processing; Contract Administrator; Other services; Float revenue; Named fiduciary Service code 12 | — | $232K |
| FST ASSOCIATES, INC. EIN 36-3832755 BROKER | Other commissions Service code 55 | — | $37K |
| CIGNA | Contract Administrator; Direct payment from the plan; Other services; Participant communication; Claims processing; Non-monetary compensation; Named fiduciary; Float revenue Service code 12 | — | $0 |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Other commissions Service code 55 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $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 | 7,022 | 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) | 7,022 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 2,744 | $740K |
| Vision(2 contracts) | EYEMED VISION CARE | 10,632 | $443K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 7,022 | $526K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 6,206 | $1.0M |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 10,871 | $1.0M |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY | 10,871 | $1.0M |
| Other(4 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 7,025 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,871 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.