| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COTTINGHAM & BUTLER3 Filed as: COTTINGHAM & BUTLER, INC. | PO BOX 28 300 SECURITY BUILDING DUBUQUE, IA 52004 | AETNA LIFE INSURANCE CO | $143K | — | $143K | 8.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | EMPLOYEE BENEFITS DEPARTMENT 55 EAST JACKSON BLVD #14A CHICAGO, IL 60604 | AETNA LIFE INSURANCE CO | — | $7K | $7K | 0.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | ATTN EMP BENEFITS DEPT 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | RELIASTAR LIFE INSURANCE COMPANY | $165K | $7K | $172K | 66.20% |
| CHRISTA G AUFDEMBERG INC4 Filed as: CHRISTA G. AUFDEMBERG INC. | 13102 BRITTANY WOODS DRIVE TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES, INC. D/B/A LEGALSHIELD | $548 | — | $548 | 7.94% |
| SANDRA SIMS4 Filed as: SANDRA ALLEN | 501 AGUA PLACE SEAL BEACH, CA 90740 | PRE-PAID LEGAL SERVICES, INC. D/B/A LEGALSHIELD | $155 | — | $155 | 2.25% |
| MARIA SCHWARTZ4 | 312 VIA PROMESA SAN CLEMENTE, CA 92673 | PRE-PAID LEGAL SERVICES, INC. D/B/A LEGALSHIELD | $129 | — | $129 | 1.87% |
| AMY EVANS4 | 14431 VENTURA BLVD STE 514 SUITE 740 SHERMAN OAKS, CA 91423 | PRE-PAID LEGAL SERVICES, INC. D/B/A LEGALSHIELD | $59 | — | $59 | 0.86% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | 200 LIBERTY STREET NEW YORK, NY 10281 | FEDERAL INSURANCE COMPANY | $0 | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVEUNE HARTFORD, CT 06156 | $1.3M |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $91K |
| COTTINGHAM AND BUTLER INS SERVICES EIN 42-0198040 BROKER | Other commissions Service code 55 | — | $0 |
| FOREST FINANCIAL GROUP INC EIN 36-4242869 BROKER | Other commissions Service code 55 | — | $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 | 2,498 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 61 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,559 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 1,152 | $5.8M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 1,736 | $223K |
| Life insurance | AETNA LIFE INSURANCE CO | 2,523 | $1.6M |
| Long-term disability | AETNA LIFE INSURANCE CO | 2,523 | $1.6M |
| Other(4 contracts, 4 carriers) | AETNA LIFE INSURANCE CO | 2,523 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,523 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.