| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $7K | $7K | 1.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $488 | $488 | 1.14% |
| F.B.P. INSURANCE SERVICES, LLC3 Filed as: F B P INSURANCE SERVICES | 130 THEORY STREET, SUITE 200 IRVINE, CA 92617 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $206 | $206 | 0.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $367 | $4K | 11.56% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 500 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $394 | — | $394 | 1.06% |
| F.B.P. INSURANCE SERVICES, LLC3 Filed as: F B P INSURANCE SERVICES | 130 THEORY STREET, SUITE 200 IRVINE, CA 92617 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $140 | $140 | 0.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 11.65% |
| BB&H BENEFIT DESIGNS3 | 109 E VICTORIA STREET SANTA BARBARA, CA 93101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $347 | — | $347 | 1.07% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $178 | $178 | 0.55% |
| PANTALONE, JO, ANN3 Filed as: PANTALONE, LOUIS, JOSEPH | CUSTOM BENEFITS PROGRAMS INC. 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $73 | — | $73 | 0.23% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFITS PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $34 | $23 | $57 | 0.18% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $92 | $4K | 20.17% |
| BB&H BENEFIT DESIGNS3 | 109 E VICTORIA STREET SANTA BARBARA, CA 93101 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $230 | — | $230 | 1.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $511 | $78 | $589 | 8.38% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DRIVE, SUITE 500 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $46 | — | $46 | 0.65% |
| F.B.P. INSURANCE SERVICES, LLC3 Filed as: F B P INSURANCE SERVICES | 130 THEORY STREET, SUITE 200 IRVINE, CA 92612 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $31 | $31 | 0.44% |
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 | 345 | 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) | 347 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTHCARE OF CALIFORNIA | 351 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 118 | $529K |
| Vision | EYEMED VISION CARE | 414 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 338 | $37K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 67 | $32K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 340 | $43K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTHCARE OF CALIFORNIA | 351 | $2.2M |
| Other(3 contracts, 3 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 338 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 414 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.