| 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 | $76K | — | $76K | 5.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 13.78% |
| MICHELLE C. LEE3 Filed as: MICHELLE C LEE | 1044 LOMA LISA LANE ARCADIA, CA 91006 | AFLAC | $1K | — | $1K | 8.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $1K | — | $1K | 7.61% |
| KATHLEEN A. DUFFY INSURANCE SERVICE3 Filed as: KATHLEEN A DUFFY-LARSON | 10442 ORMOND STREET SHADOW HILLS, CA 91040 | AFLAC | $883 | — | $883 | 5.36% |
| KATHY DUFFY INSURANCE SERVICES3 | 10442 ORMOND STREET SHADOW HILLS, CA 91040 | AFLAC | $735 | — | $735 | 4.46% |
| BRENDA A HUERTA3 | 24405 CHESNUT STREET SUITE 103 SANTA CLARITA, CA 91321 | AFLAC | $332 | — | $332 | 2.02% |
| ACRISURE LLC3 | 888 W. 6TH STREET SUITE 500 LOS ANGELES, CA 90017 | AFLAC | $253 | — | $253 | 1.54% |
| MICHAEL R. FISHER3 Filed as: MICHAEL R FISHER | 50 W. LEMON AVENUE SUITE 2 MONROVIA, CA 91016 | AFLAC | $141 | — | $141 | 0.86% |
| MICHAEL R. FISHER3 Filed as: MICHAEL R FISHER | 337 S. ALMANSOR COURT APT. F ALHAMBRA, CA 91801 | AFLAC | $119 | — | $119 | 0.72% |
| BRENDA A HUERTA3 | 659 JUNCTION DRIVE APT. D115 ALLEN, TX 75013 | AFLAC | $41 | $78 | $119 | 0.72% |
| HILDA HUERTA3 | 24405 CHESTNUT STREET SUITE 103 SANTA CLARITA, CA 91321 | AFLAC | $104 | — | $104 | 0.63% |
| JENNIFER KARSTING3 | 17671 COWAN SUITE 125 IRVINE, CA 92614 | AFLAC | $104 | — | $104 | 0.63% |
| ALYSSA JOAN GUBA3 | 15222 TAYLOR WAY TUSTIN, CA 92782 | AFLAC | $62 | — | $62 | 0.38% |
| LISA ANN ARENS3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $46 | — | $46 | 0.28% |
| ROY DANIELS VILLALOBOS3 Filed as: ROY DANIEL VILALOBOS | 12011 163RD STREET NORWALK, CA 90650 | AFLAC | $46 | — | $46 | 0.28% |
| JASON DAVIS INSURANCE SERVICES INC3 | 10571 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $44 | — | $44 | 0.27% |
| BLANCA DAVIS3 Filed as: BLANCA A DAVIS | 10571 CALLE LEE SUITE 171 LOS ALAMITOS, CA 90720 | AFLAC | $44 | — | $44 | 0.27% |
| CASSANDRA GREEN3 | 10541 CALLE LEE SUITE 215 LOS ALAMITOS, CA 90720 | AFLAC | $39 | — | $39 | 0.24% |
| EXECUTIVE CONSULTANTS GROUP INC.3 Filed as: EXECUTIVE CONSULTANTS GROUP INC | 1936 E. DEERE AVENUE SUITE 215 SANTA ANA, CA 92705 | AFLAC | $39 | — | $39 | 0.24% |
| MICHAEL G. TURNER3 Filed as: MICHAEL G TURNER | 4657 GUAVA AVENUE SEAL BEACH, CA 90740 | AFLAC | $18 | — | $18 | 0.11% |
| ANDREW R GRETHEL3 Filed as: ANDREW R. GRETHEL | 11739 HICKORY RUN COURT LOVELAND, OH 45140 | AFLAC | $17 | — | $17 | 0.10% |
| JAMES J GRETHEL3 | 865 CEDAR DRIVE LOVELAND, OH 45140 | AFLAC | $4 | — | $4 | 0.02% |
| VANZANTEN INSURANCE SERVICES INC3 | 33530 PAUBA ROAD TEMECULA, CA 92592 | AFLAC | $4 | — | $4 | 0.02% |
| MEGAN K DENNIS3 | 6842 E. EL CARMEN STREET LONG BEACH, CA 90815 | AFLAC | $4 | — | $4 | 0.02% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DRIVE SUITE 1150 IRVINE, CA 92612 | AFLAC | $2 | — | $2 | 0.01% |
| SEAN C. ARENS3 Filed as: SEAN C ARENS | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $2 | — | $2 | 0.01% |
| DALE I DAVIS3 | 1856 TRAVELLER ROAD LEXINGTON, KY 40504 | AFLAC | $1 | — | $1 | 0.01% |
| OWEN JOHNSTON3 | 796 N. HART STREET ORANGE, CA 92867 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $455 | — | $455 | 15.00% |
| PATRICIA SWANSON4 | 579 W. LEMON AVENUE MONROVIA, CA 91016 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $924 | — | $924 | 33.69% |
| VERONICA TICE4 | 2505 SPRINGBROOK DRIVE LAS VEGAS, NV 89134 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $200 | — | $200 | 7.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $402 | — | $402 | 14.99% |
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 | 143 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 149 | $1.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 149 | $1.4M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 149 | $1.4M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 142 | $17K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 48 | $3K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 143 | $26K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 149 | $1.4M |
| Other(3 contracts, 3 carriers) | AFLAC | 142 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.