| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 60604 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $267 | $267 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERENATIONAL MIDWEST LIMITED | 55 E JACKSON BLVD CHICAGO, IL 606044466 | PRINCIPAL LIFE INSURANCE COMPANY | $21K | — | $21K | 14.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 300 N LASALLE ST 17TH FLOOR CHICAGO, IL 60654 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 2.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | EYEMED VISION CARE | $816 | — | $816 | 9.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $40K |
| HUB INTERNATIONAL MIDWEST LTD BROKER | Other commissions Service code 55 | 55 E JACKSKON BLVD CHICAGO, IL 60604 | $31K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $29K |
| CIGNA | Participant communication; Named fiduciary; Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Other services 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 | 124 | 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) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 76 | $470K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $142K |
| Vision | EYEMED VISION CARE | 114 | $8K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $142K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $142K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 179 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.