| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA HEALTH, INC. | $33K | $0 | $33K | 4.12% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS INC | 1520 BRIDGEWATER DRIVE DIAMOND BAR, CA 91765 | AETNA HEALTH, INC. | $7K | $0 | $7K | 0.87% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN, INC. | $13K | $0 | $13K | 2.85% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS INC | 1520 BRIDGEWATER DRIVE SUITE 108 DIAMOND BAR, CA 91765 | KAISER FOUNDATION HEALTH PLAN, INC. | $5K | $0 | $5K | 1.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $8K | $4K | $12K | 9.02% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS INC | 1520 BRIDGEWATER DRIVE DIAMOND BAR, CA 91765 | AETNA LIFE INSURANCE CO. | $2K | $0 | $2K | 1.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $732 | $1K | $2K | 12.95% |
| IMA, INC.3 | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $319 | $0 | $319 | 2.38% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS INC | 1520 BRIDGEGATE DR STE 108 DIAMOND BAR, CA 91765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $287 | $0 | $287 | 2.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $354 | $351 | $705 | 10.24% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS INC | 1520 BRIDGEGATE DR STE 108 DIAMOND BAR, CA 91765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $178 | $0 | $178 | 2.59% |
| IMA, INC.3 | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $156 | $0 | $156 | 2.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $140 | $153 | $293 | 10.92% |
| IMA, INC.3 | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $65 | $0 | $65 | 2.42% |
| COMBINED SERVICES LLC3 Filed as: COMBINED BENEFITS INC | 1520 BRIDGEGATE DR STE 108 DIAMOND BAR, CA 91765 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $64 | $0 | $64 | 2.39% |
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 | 211 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH, INC. | 222 | $1.4M |
| Dental | AETNA LIFE INSURANCE CO. | 222 | $138K |
| Vision | AETNA LIFE INSURANCE CO. | 222 | $138K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 211 | $20K |
| Prescription drug(2 contracts, 2 carriers) | AETNA HEALTH, INC. | 142 | $1.3M |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 211 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 222 | — |
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.