| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 NEW YORK, NY 10087 | AETNA LIFE INSURANCE CO. | $94K | — | $94K | 1.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $39K | — | $39K | 0.80% |
| WILLIS TOWERS WATSON US LLC3 | P.O. BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $40K | — | $40K | 2.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | $2 | $18K | 0.93% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | $15K | $30K | 6.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $8K | $16K | 3.45% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $14K | $14K | $28K | 6.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $7K | $14K | 3.38% |
| WILLIS TOWERS WATSON US LLC3 | P.O. BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 2.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 0.93% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $7K | $15K | 6.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $4K | $8K | 3.62% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 6255 SUDBURY DRIVE DALLAS, TX 75214 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $3K | $6K | 6.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $2K | $3K | 3.04% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 100878852 | EYEMED VISION CARE | $8K | — | $8K | 10.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | EYEMED VISION CARE | $3K | — | $3K | 3.11% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 10087 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $1K | — | $1K | 2.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $386 | — | $386 | 0.67% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 10087 | METLIFE LEGAL PLANS | $2K | — | $2K | 6.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METLIFE LEGAL PLANS | $1K | — | $1K | 3.79% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 10087 | METLIFE LEGAL PLANS | — | $422 | $422 | 1.58% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 100878852 | EYEMED VISION CARE | $383 | — | $383 | 9.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | EYEMED VISION CARE | $113 | — | $113 | 2.75% |
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 | 787 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 60 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 847 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 1,506 | $7.2M |
| Dental | AETNA LIFE INSURANCE CO. | 1,506 | $4.9M |
| Vision(2 contracts) | EYEMED VISION CARE | 1,290 | $86K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 787 | $424K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 787 | $220K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 787 | $455K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 291 | $2.3M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 787 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,506 | — |
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.