| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | $63K | — | $63K | 5.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | OXFORD HEALTH INSURANCE, INC. | $6K | — | $6K | 3.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | $2K | $10K | 9.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $304 | $3K | 18.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $984 | — | $984 | 10.14% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH #200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $197 | — | $197 | 2.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $628 | $4 | $632 | 7.06% |
| VAN EPPS, JAMES, H3 Filed as: VAN EPPS, JAMES, H. | 10930 CRABAPPLE RD. SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $162 | $7 | $169 | 1.89% |
| BLOCK, CHARLES, D3 Filed as: BLOCK, CHARLES, D. | UNIT 208 648 VILLAGE PARK DR. WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $162 | $7 | $169 | 1.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $461 | — | $461 | 14.21% |
| VAN EPPS, JAMES, H3 Filed as: VAN EPPS, JAMES, H. | 10930 CRABAPPLE RD. SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $196 | $10 | $206 | 6.35% |
| BLOCK, CHARLES, D3 Filed as: BLOCK, CHARLES, D. | UNIT 208 648 VILLAGE PARK DR. WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $196 | $10 | $206 | 6.35% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $21 | $21 | 0.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | FIRST UNUM LIFE INSURANCE COMPANY | $227 | — | $227 | 19.12% |
| VAN EPPS, JAMES, H3 Filed as: VAN EPPS, JAMES, H. | 10930 CRABAPPLE RD. SUITE 206 ROSWELL, GA 30075 | FIRST UNUM LIFE INSURANCE COMPANY | $105 | $5 | $110 | 9.27% |
| BLOCK, CHARLES, D3 Filed as: BLOCK, CHARLES, D. | UNIT 208 648 VILLAGE PARK DR. WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $105 | $5 | $110 | 9.27% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | FIRST UNUM LIFE INSURANCE COMPANY | — | $11 | $11 | 0.93% |
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 | 136 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 141 | 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 AND AFFILIATES ('CIGNA') | 94 | $1.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 94 | $1.2M |
| Vision | EYEMED VISION CARE | 91 | $10K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 25 | $15K |
| Short-term disability(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $103K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 136 | $98K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 26 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 136 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.