| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $110K | $3K | $113K | 5.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UPMC HEALTH OPTIONS | $10K | — | $10K | 3.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | $568 | $746 | $1K | 0.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $1K | — | $1K | 3.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UPMC HEALTH OPTIONS | $536 | — | $536 | 3.24% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE | SERVICES, INC. 1420 5TH AVE., SUITE 1500 SEATTLE, WA 98101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $783 | — | $783 | 6.33% |
| LAWRENCE A. MANTELL & ASSOCIATES3 | INC. 16055 VENTURA BLVD., SUITE 1100 ENCINO, CA 91436 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $652 | — | $652 | 5.27% |
| WANGLIN, RONALD, CHASE3 | P.O. BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $161 | $57 | $218 | 1.76% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC. | ATT. ERICA MENDEZ 1301 DOVE ST., SUITE 200 NEWPORT BEACH, CA 92660 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $126 | $126 | 1.02% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN RD. SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $18 | $18 | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $270 | — | $270 | 10.00% |
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 | 233 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 236 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 233 | $2.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 217 | $148K |
| Vision | VISION SERVICE PLAN | 218 | $39K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 233 | $2.1M |
| Short-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 233 | $2.1M |
| Long-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 233 | $2.1M |
| Prescription drug(2 contracts) | UPMC HEALTH OPTIONS | 67 | $338K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 233 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 233 | — |
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.