| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 E JACKSON BLVD CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $36K | — | $36K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E. JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $34K | $10K | $44K | 6.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 60693 | VISION SERVICE PLAN | $7K | — | $7K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $12K | $3K | $15K | 6.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD, 14TH FLOOR A CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $11K | $3K | $14K | 6.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARTMENT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | $1K | — | $1K | 2.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIM ADMINISTRATOR | Named fiduciary; Direct payment from the plan; Non-monetary compensation; Float revenue; Contract Administrator; Claims processing; Other services; Participant communication Service code 12 | — | $1.2M |
| HUB INTERNATIONAL MIDWEST LTD EIN 13-3621603 BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $122K |
| LIBERTY LIFE ASSURANCE CO OF BOSTON EIN 04-6076039 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Insurance services Service code 12 | — | $56K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Participant communication; Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $38K |
| DISCOVERY BENEFITS EIN 90-0058554 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $27K |
| RX BENEFITS INC. EIN 63-1157085 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
| HUB INTERNATIONAL MIDWEST LIMITED BROKER | Insurance agents and brokers Service code 22 | 55 E JACKSON BLVD CHICAGO, IL 60604 | $1K |
| CIGNA | Float revenue; Other services; Named fiduciary; Participant communication; Claims processing; Direct payment from the plan; Foreign entity (e.g., an agent or broker, bank, insurance company, etc. not operating within jurisdictional boundaries of the United States); Non-monetary compensation; Contract Administrator 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 | 1,865 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 219 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,084 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,418 | $10K |
| Dental | AETNA LIFE INSURANCE COMPANY AND AFFILIATES | 251 | $59K |
| Vision | VISION SERVICE PLAN | 1,281 | $223K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,865 | $633K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 555 | $219K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 909 | $204K |
| Stop-loss / reinsurancereinsurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,192 | $718K |
| Other | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,865 | $633K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,865 | — |
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.