| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $61K | — | $61K | 2.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $51K | $3K | $55K | 2.43% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $4K | $15K | 6.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $161 | $11K | 4.46% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | — | $11K | 4.41% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 Filed as: BOON CHAPMAN BENEFIT AMINISTRATORS | P.O. BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 0.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $28K | — | $28K | 14.65% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | BLUE CROSS OF CALIFORNIA | $3K | — | $3K | 1.31% |
| KOUZMANOFF FINANCIAL AND INS. SVCS.3 | 1845 S. ELENA AVE., STE. 100A REDONDO BEACH, CA 90277 | STANDARD INSURANCE COMPANY | $5K | — | $5K | 4.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $13K | — | $13K | 14.65% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 1.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $161 | $5K | 13.89% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 13.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $161 | $4K | 16.24% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRIVNE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 15.26% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $940 | $188 | $1K | 4.99% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | -$797 | — | -$797 | — |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | -$2K | $161 | -$2K | — |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | -$2K | $161 | -$2K | — |
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 | 203 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 171 | $2.5M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 399 | $340K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 399 | $251K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 203 | $89K |
| Long-term disability | STANDARD INSURANCE COMPANY | 166 | $120K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 171 | $2.5M |
| Other(4 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 203 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 399 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.