| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $18K | — | $18K | 5.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $7K | — | $7K | 5.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $6K | — | $6K | 5.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARTMENT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $530 | — | $530 | 1.41% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIM ADMINISTRATOR | Float revenue; Direct payment from the plan; Contract Administrator; Other services; Non-monetary compensation; Named fiduciary; Participant communication; Claims processing Service code 12 | — | $340K |
| HUB INTERNATIONAL BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $37K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $33K |
| VISION SERVICE PLAN EIN 06-1227840 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $18K |
| LIBERTY MUTUAL LEAVE SERVICES EIN 04-6076039 CONTRACT ADMINISTRATOR | Insurance services; Claims processing; Contract Administrator Service code 12 | — | $16K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Claims processing; Participant communication Service code 12 | — | $12K |
| LIBERTY MUTUAL EIN 04-6076039 CONTRACT ADMINISTRATOR | Insurance services; Contract Administrator; Claims processing Service code 12 | — | $7K |
| CIGNA | Other services; Participant communication; Contract Administrator; Claims processing; Float revenue; Named fiduciary; Non-monetary compensation; Foreign entity (e.g., an agent or broker, bank, insurance company, etc. not operating within jurisdictional boundaries of the United States); 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 | 1,233 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,235 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,233 | $6K |
| Dental | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 262 | $38K |
| Vision(2 contracts) | VISION SERVICE PLAN | 1,072 | $110K |
| Life insurance(2 contracts) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,429 | $351K |
| Short-term disability(2 contracts) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 419 | $136K |
| Long-term disability(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 763 | $119K |
| Other(2 contracts) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,429 | $351K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,429 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.