| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 5435 CORPORATE DR STE 260 TROY, MI 48098 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | — | $6K | 3.92% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 MOUNTAIN BRK, AL 35223 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | — | $6K | 3.87% |
| ROGERS BENEFIT GROUP INC3 | 130 N BRAND BLVD SUITE 310 GLENDALE, CA 91203 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $2K | $2K | 1.57% |
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS OF ARIZONA LLC | 4544 E CAMP LOWELL DR TUCSON, AZ 85712 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $1K | $1K | 0.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 E JACKSON BLVD CHICAGO, IL 60604 | DELTA DENTAL OF ARIZONA | $2K | — | $2K | 5.64% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 BIRMINGHAM, AL 35223 | DELTA DENTAL OF ARIZONA | $1K | — | $1K | 4.27% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF ARIZONA, LLC | 4544 E CAMP LOWELL DR TUCSON, AZ 85712 | DELTA DENTAL OF ARIZONA | $419 | — | $419 | 1.33% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 MOUNTAIN BRK, AL 35223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $654 | — | $654 | 8.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 5435 CORPORATE DR STE 260 TROY, MI 48098 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $532 | — | $532 | 6.73% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 MOUNTAIN BRK, AL 35223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $506 | — | $506 | 7.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 5435 CORPORATE DR STE 260 TROY, MI 48098 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $446 | — | $446 | 7.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 E JACKSON BLVD CHICAGO, IL 60604 | DELTA DENTAL OF ARIZONA | $261 | — | $261 | 5.59% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 BIRMINGHAM, AL 35223 | DELTA DENTAL OF ARIZONA | $198 | — | $198 | 4.24% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 MOUNTAIN BRK, AL 35223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $71 | — | $71 | 8.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 5435 CORPORATE DR STE 260 TROY, MI 48098 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $62 | — | $62 | 7.01% |
| COBBS ALLEN & HALL INC3 Filed as: COBBS ALLEN CAPITAL LLC | 115 OFFICE PARK DRIVE SUITE 200 MOUNTAIN BRK, AL 35223 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $64 | — | $64 | 8.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 5435 CORPORATE DR STE 260 TROY, MI 48098 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $55 | — | $55 | 6.92% |
No Schedule C service providers reported on this filing.
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 99 | $149K |
| Dental | DELTA DENTAL OF ARIZONA | 142 | $31K |
| Vision | DELTA DENTAL OF ARIZONA | 131 | $5K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $7K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 113 | $795 |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 99 | $149K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 142 | — |
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.