| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $56K | $0 | $56K | 15.06% |
| MARSH & MCLENNAN AGENCY LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $7K | $0 | $7K | 1.98% |
| FMLA SOURCE INC3 | 455 N CITYFRONT PLZ DR 13TH FL CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $6K | $6K | 19.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 13.39% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $527 | $3K | $4K | 10.81% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 13.57% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $362 | $2K | $2K | 9.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 13.37% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $347 | $2K | $2K | 10.96% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $325 | $2K | $2K | 12.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 13.34% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $163 | $943 | $1K | 11.31% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $247 | $247 | 2.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 21.63% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $232 | $708 | $940 | 13.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL TEXAS INC | 10000 N CENTRAL EXPRESSWAY STE 1200 DALLAS, TX 75231 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 21.39% |
| MARSH & MCLENNAN AGENCY LLC3 | 2500 CITYWEST BLVD, STE 2400 STE 2400 HOUSTON, TX 77042 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $203 | $664 | $867 | 15.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $31K |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 22 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 16 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 300 | $373K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 300 | $373K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 91 | $18K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $35K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $21K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.