| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BOULEVARD 14TH FLOOR A CHICAGO, IL 60604 | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | — | $7K | $7K | 1.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 55 E JACKSON BLVD CHICAGO, IL 60604 | METROPOLITAN LIFE INSURANCE COMPANY | $21K | — | $21K | 5.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 40 W MADISON 4TH FL BANK OF AMERICA LOCK BOX SVCS CHICAGO, IL 60693 | METROPOLITAN LIFE INSURANCE COMPANY | — | $5K | $5K | 1.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $4K | — | $4K | 1.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD. CHICAGO, IL 60604 | EYEMED VISION CARE | $10K | — | $10K | 3.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF KENTUCKY, INC. | $2K | — | $2K | 1.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF FLORIDA, INC. | $682 | — | $682 | 1.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF TEXAS, INC. | $217 | — | $217 | 1.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSN BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH PLAN OF ARIZONA, INC. | $154 | — | $154 | 1.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF CALIFORNIA, INC. | $131 | — | $131 | 1.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF MISSOURI, INC. | $101 | — | $101 | 1.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF OHIO, INC. | $124 | — | $124 | 1.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF MARYLAND, INC. | $53 | — | $53 | 1.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF COLORADO, INC | $27 | — | $27 | 1.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNTIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF PENNSYLVANIA, INC. | $29 | — | $29 | 1.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF VIRGINIA, INC. | $46 | — | $46 | 1.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA DENTAL HEALTH OF NORTH CAROLINA, INC. | $30 | — | $30 | 1.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITEDHEALTH CARE SERVICES, INC EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $1.4M |
| LINCOLN LIFE ASSURANCE CO OF BOSTON EIN 04-6076039 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $178K |
| CIGNA HEALTH & LIFE INSURANCE EIN 59-1031071 PLAN ADMINISTRATOR | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $129K |
| HUB INTERNATIONAL MIDWEST LIMITED EIN 35-0672425 BROKER | Other commissions Service code 55 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $16K |
| CIGNA | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | — | $0 |
| HUB INTERNATIONAL MIDWEST LTD 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 | 4,927 | 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) | 4,927 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(13 contracts, 13 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 915 | $496K |
| Vision | EYEMED VISION CARE | 4,860 | $243K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 3,298 | $420K |
| Long-term disability | LINCOLN LIFE ASSURANCE COMPANY OF BOSTON | 3,242 | $532K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY | 4,927 | $842K |
| Other(5 contracts, 5 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 4,927 | $1.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,927 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.