| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | CIGNA HEALTHCARE OF CALIFORNIA | $24K | $0 | $24K | 0.30% |
| LOCKTON COMPANIES, LLC3 | 4275 EXECUTIVE SQUARE, SUITE 600 LA JOLLA, CA 92037 | METROPOLITAN LIFE INSURANCE COMPANY | $57K | $95 | $58K | 7.33% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | METROPOLITAN LIFE INSURANCE COMPANY | $40K | $14K | $54K | 6.86% |
| EMPYREAN INSURANCE SERVICES, INC.3 Filed as: EMPYREAN INSURANCE SERVICES INC. | PO BOX 2569 BELLAIRE, TX 77402 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $39K | $39K | 4.92% |
| LOCKTON COMPANIES, LLC3 | PO BOX 879610 KANSAS CITY, MO 64187 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $3K | $3K | 0.44% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $11K | $11K | 9.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $481 | $0 | $481 | 0.40% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | HYATT LEGAL PLANS | $2K | $0 | $2K | 10.02% |
| LOCKTON COMPANIES, LLC3 | 111 EST KILBOURN AVENUE, SUITE 825 MILWAUKEE, WI 53202 | HYATT LEGAL PLANS | $0 | $268 | $268 | 1.17% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | HYATT LEGAL PLANS | $0 | $95 | $95 | 0.41% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | HYATT LEGAL PLANS | $0 | $66 | $66 | 0.29% |
| LOCKTON COMPANIES, LLC3 | PO BOX 843844 KANSAS CITY, MO 64184 | HYATT LEGAL PLANS | $0 | $66 | $66 | 0.29% |
| LOCKTON COMPANIES, LLC3 | 15939 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 | HYATT LEGAL PLANS | $0 | $37 | $37 | 0.16% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $72 | $0 | $72 | 1.55% |
| EOI SERVICE COMPANY INC3 Filed as: EOI SERVICE COMPANY INC. | 1820 EAST 1ST STREET, SUITE 400 SANTA ANA, CA 92705 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $44 | $0 | $44 | 0.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $44 | $0 | $44 | 0.95% |
| DALE ALLEN NICHOLS3 | 728 LEGENDS CREST DRIVE FRANKLIN, TN 37069 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $29 | $0 | $29 | 5.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 40 REDLANDS, CA 92373 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 2.34% |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTHCARE OF CALIFORNIA | 2,301 | $8.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,301 | $121K |
| Vision | EYEMED VISION CARE ON BEHALF OF COMBINED INSURANCE COMPANY OF AMERICA | 2,357 | $116K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,887 | $785K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,887 | $785K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,887 | $785K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTHCARE OF CALIFORNIA | 2,301 | $8.0M |
| Other(5 contracts, 5 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 3,923 | $843K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,923 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.