| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 3135 ALBUQUERQUE, NM 871903135 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $86K | — | $86K | 11.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS | 580 N BANK LN LAKE FOREST, IL 60045 | DELTA DENTAL OF NEW MEXICO | $5K | — | $5K | 4.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS | PO BOX 2158 RIVERSIDE, CA 925162158 | VISION SERVICE PLAN | $1K | — | $1K | 5.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 9.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL MIDWEST LTD | 1591 GALBRAITH AVE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | $0 | $530 | $530 | 2.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURACE CO EIN 59-1031071 SERVICE PROVIDER | Float revenue; Claims processing; Direct payment from the plan; Named fiduciary; Other services; Non-monetary compensation; Contract Administrator; Participant communication Service code 12 | — | $24K |
| CIGNA | Named fiduciary; Participant communication; Claims processing; Float revenue; Contract Administrator; Employee (plan); Other services; Non-monetary compensation; Direct payment from the plan Service code 12 | — | $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 | 249 | 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) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 230 | $751K |
| Dental | DELTA DENTAL OF NEW MEXICO | 303 | $103K |
| Vision | VISION SERVICE PLAN | 159 | $25K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 249 | $18K |
| Other | HARTFORD LIFE AND ACCIDENT | 249 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.