| 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 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $96K | $1K | $97K | 5.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CIGNA HEALTHCARE OF CALIFORNIA | $130K | — | $130K | 26.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $47K | — | $47K | 15.00% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $12K | $4K | $15K | 10.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $71 | $4K | 2.98% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $39 | $39 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $20K | — | $20K | 15.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | EYEMED VISION CARE | $5K | — | $5K | 5.97% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH, #200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $2K | — | $2K | 1.99% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST. HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $18K | $3K | $21K | 33.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $44 | $4K | 7.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 15.00% |
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 | 685 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 695 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,396 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,396 | $1.7M |
| Vision | EYEMED VISION CARE | 1,330 | $85K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 685 | $456K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 457 | $142K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 685 | $134K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,396 | $1.7M |
| Other(3 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 685 | $230K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,396 | — |
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.