| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $110K | — | $110K | 4.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA HEALTH, INC. | $87K | — | $87K | 4.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | — | $13K | 3.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91102 | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $24K | — | $24K | 14.34% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 S. THIRD STREET SUITE 800 COLUMBUS, OH 43215 | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $43 | — | $43 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $15K | — | $15K | 15.00% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $117 | $117 | 0.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $8K | — | $8K | 15.00% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $56 | $56 | 0.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $50 | $50 | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $850 | — | $850 | 15.00% |
| BENEFIT ADVISORS NETWORK LLC3 | 6830 COCHRAN ROAD SOLON, OH 44139 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $10 | $10 | 0.18% |
| BRIAN SANDERSON4 | 1503 N. GRAND OAKS AVENUE PASADENA, CA 91104 | PRE-PAID LEGAL SERVICES, INC., DBA LEGAL SHIELD | $439 | — | $439 | 9.53% |
| MARY THERESA FISHER4 | 29C OWENS LANDING COURT PERRYVILLE, MD 21903 | PRE-PAID LEGAL SERVICES, INC., DBA LEGAL SHIELD | $47 | — | $47 | 1.02% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES, INC., DBA LEGAL SHIELD | $28 | — | $28 | 0.61% |
| THE NATHAN GROUP INC.4 | 817 KETTERING CLOSE ANTIOCH, TN 37013 | PRE-PAID LEGAL SERVICES, INC., DBA LEGAL SHIELD | $18 | — | $18 | 0.39% |
| DAVID PAPERNO4 | 817 GRAPE ARBOR AVENUE PALM DESERT, CA 92211 | PRE-PAID LEGAL SERVICES, INC., DBA LEGAL SHIELD | $14 | — | $14 | 0.30% |
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 | 486 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 489 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 443 | $4.9M |
| Dental | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 486 | $167K |
| Vision | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 486 | $167K |
| Life insurance(2 contracts, 2 carriers) | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 583 | $270K |
| Short-term disability(2 contracts, 2 carriers) | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 486 | $221K |
| Long-term disability(2 contracts, 2 carriers) | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 486 | $209K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 76 | $430K |
| Other(4 contracts, 3 carriers) | TH GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 583 | $280K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 583 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.