| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $81K | $1K | $82K | 3.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 3.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $21 | $14K | 6.52% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 S. 3RD ST., SUITE 800 COLUMBUS, OH 432155194 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 1.15% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | INC. 32110 AGOURA RD. WESTLAKE VILLAGE, CA 913614026 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 3.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 3.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $2K | $6K | 13.16% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $1K | $6K | 12.73% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $292 | $2K | 12.34% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $500 | $500 | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $481 | — | $481 | 8.58% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 S. 3RD ST., SUITE 800 COLUMBUS, OH 432155194 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $74 | — | $74 | 1.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION | $47 | — | $47 | 3.32% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 S. 3RD ST., SUITE 800 COLUMBUS, OH 432155194 | SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION | $24 | — | $24 | 1.70% |
No Schedule C service providers reported on this filing.
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 | 255 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 186 | $2.9M |
| Dental(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 525 | $228K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 525 | $221K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 255 | $49K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 255 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 255 | $47K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 255 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 525 | — |
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."
No prospect flags tripped on this filing.