| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AETNA LIFE INSURANCE COMPANY | $120K | $441 | $120K | 4.26% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | AETNA LIFE INSURANCE COMPANY | $24K | $83 | $24K | 0.86% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | AETNA HEALTH, INC. | $73K | $0 | $73K | 4.04% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 600 TORRANCE, CA 90503 | AETNA HEALTH, INC. | $16K | $0 | $16K | 0.89% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 550 SOUTH HOPE STREET, SUITE 1000 LOS ANGELES, CA 90071 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $18K | $0 | $18K | 11.27% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $7K | $7K | 4.68% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 3.72% |
| PLANSOURCE BEN ADMINISTRATION INC5 Filed as: PLANSOURCE BEN ADMINISTRATION, INC. | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 3.20% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $4K | $0 | $4K | 8.25% |
| JOHNSON RESOURCES3 | 7373 EAST DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $866 | $0 | $866 | 1.82% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $408 | $0 | $408 | 0.86% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 21.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $152 | $0 | $152 | 1.05% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INSURANCE | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 16.65% |
| USI INSURANCE SERVICES LLC3 | PO BOX 9004 VAN NUYS, CA 91409 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $145 | $0 | $145 | 1.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $52 | $0 | $52 | 0.49% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $2K | $0 | $2K | 22.50% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $110 | $0 | $110 | 1.21% |
| DOMINIC A. NACCHIA4 | 201 CAROLINA POINT PARKWAY APARTMENT 206 GREENVILLE, SC 29607 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $22 | $0 | $22 | 0.24% |
| ROBERT SHEESLEY4 | 6 WOODMAN WAY, UNIT 311A NEWBERRY PORT, MA 01950 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $16 | $0 | $16 | 0.18% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $158 | $0 | $158 | 1.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $141 | $0 | $141 | 1.65% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | $0 | $69 | 0.81% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | $0 | $63 | 0.74% |
| DEL DOWNEY3 Filed as: DEL DOWNEY AND OTHER AGENTS | 32056 MERLOT CREST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $0 | $59 | 0.69% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | $0 | $49 | 0.57% |
| JAMES H CROUTHAMEL3 Filed as: JAMES H. CROUTHAMEL | 1308 CUSHMORE ROAD SOUTHAMPTON, PA 18966 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | $0 | $42 | 0.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | FIRST UNUM LIFE INSURANCE COMPANY | $9 | $0 | $9 | 2.05% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | $0 | $5 | 2.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | PO BOX 6030 PASADENA, CA 91102 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | $0 | $5 | 2.45% |
| JAMES H CROUTHAMEL3 Filed as: JAMES H. CROUTHAMEL | 1308 CUSHMORE ROAD SOUTHAMPTON, PA 18966 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 1.96% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.98% |
| DEL DOWNEY3 | 32056 MERLOT CREST TEMECULA, CA 92591 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.49% |
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 | 432 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 453 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 322 | $4.6M |
| Dental | AETNA LIFE INSURANCE COMPANY | 322 | $2.8M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 522 | $48K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 432 | $156K |
| Short-term disability(4 contracts, 4 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 43 | $24K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 432 | $156K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 322 | $4.6M |
| Other(5 contracts, 5 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 432 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 522 | — |
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.