| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $69K | — | $69K | 3.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $60K | $459 | $60K | 3.50% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | CIGNA HEALTHCARE OF CALIFORNIA | $31K | — | $31K | 2.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | CIGNA HEALTHCARE OF CALIFORNIA | $27K | — | $27K | 2.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 7.74% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 7.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $1K | $3K | 7.94% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 5.42% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $598 | $598 | 1.46% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | EYEMED VISION CARE | $2K | — | $2K | 5.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | EYEMED VISION CARE | $1K | — | $1K | 4.50% |
| JOHNSON RESOURCES3 Filed as: JOHNSON RESOURCES - AZ | 7373 E. DOUBLETREE RANCH, STE. 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $571 | — | $571 | 1.99% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 8.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $590 | — | $590 | 5.04% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $580 | — | $580 | 4.95% |
| STEVE BAKER4 | 3726 SAND COURT MELBOURNE BEACH, FL 32951 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $1K | — | $1K | 13.30% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $340 | — | $340 | 3.57% |
| DOMINIC A. NACCHIA4 | P.O. BOX 76694 ATLANTA, GA 30358 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $34 | — | $34 | 0.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $454 | $25 | $479 | 5.73% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $16 | $16 | 0.19% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $563 | — | $563 | 7.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $475 | $24 | $499 | 6.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $527 | — | $527 | 7.57% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $371 | — | $371 | 5.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $219 | — | $219 | 5.05% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS SVCS INC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $215 | — | $215 | 4.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $193 | — | $193 | 4.90% |
| THE PAUL REVERE LIFE INSURANCE3 Filed as: PAUL REVERE - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | THE PAUL REVERE LIFE INSURANCE COMPANY | $17 | — | $17 | 7.62% |
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 | 447 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 449 | 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 | 539 | $2.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 539 | $1.7M |
| Vision | EYEMED VISION CARE | 447 | $29K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 447 | $55K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 22 | $8K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 447 | $41K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 539 | $2.8M |
| Other(8 contracts, 6 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 539 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 539 | — |
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.