| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $25K | $202 | $25K | 4.75% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE | ADMINISTRATORS INC. 721 S. PARKER ST. ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | — | $5K | $5K | 0.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN INC. | $8K | $1K | $9K | 5.34% |
| MICHELLE C. LEE3 Filed as: MICHELLE LEE | 1044 LOMA LISA LN. ARCADIA, CA 91006 | AFLAC | $2K | $413 | $2K | 8.92% |
| RICKY SHIH3 | 314 S. 3RD AVE. ARCADIA, CA 91006 | AFLAC | $1K | $124 | $1K | 4.48% |
| MICHAEL R. FISHER3 | 50 W. LEMON AVE. SUITE 2 MONROVIA, CA 91016 | AFLAC | $370 | $95 | $465 | 1.82% |
| RATTNAK SOKHOM3 | 403 N. NEW AVE. MONTEREY PARK, CA 91755 | AFLAC | $239 | $1 | $240 | 0.94% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH A. LENZO | 701 ALBEROSKY WAY BATAVIA, IL 60510 | AFLAC | $52 | — | $52 | 0.20% |
| DANIEL E ELLIS3 Filed as: DANIEL E. ELLIS | 377 E. BUTTERFIELD RD. SUITE 210 LOMBARD, IL 60148 | AFLAC | $38 | — | $38 | 0.15% |
| GUY M. WELCH3 | 5414 MERCEDES AVE. DALLAS, TX 75206 | AFLAC | $30 | — | $30 | 0.12% |
| ALEXANDER FIGUEROA3 | 122 E. CHESTNUT ST. GLENDALE, CA 91205 | AFLAC | $27 | $3 | $30 | 0.12% |
| LEANN C LEVINE3 Filed as: LEANN C. LEVINE | 1049 16TH ST. APT. 9 SANTA MONICA, CA 90403 | AFLAC | $27 | — | $27 | 0.11% |
| ALICIA MARGARIT ESPINOZA3 | 170 ELDORADO ST. ARCADIA, CA 91006 | AFLAC | $19 | — | $19 | 0.07% |
| KEVIN MICHAEL NAGLE3 | 32 ESPERANZA AVE. APT. F SIERRA MADRE, CA 91024 | AFLAC | $11 | — | $11 | 0.04% |
| MAYNARD M. YOUNG3 | 20 HOBBS RD. EFFINGHAM, NH 03882 | AFLAC | $11 | — | $11 | 0.04% |
| VINCENT C HING3 Filed as: VINCENT C. HING | 4536 RINETTI LN. LA CANADA, CA 91011 | AFLAC | $9 | — | $9 | 0.04% |
| ARASH JAY BEHZADI3 | 969 PEPPERHILL RD. PASADENA, CA 91107 | AFLAC | $8 | — | $8 | 0.03% |
| STEVE CRAIG GOLDSTEIN3 Filed as: STEVE CRAIG GOLSTEIN | 6255 VENTURA CANYON AVE. VAN NUYS, CA 91401 | AFLAC | $7 | — | $7 | 0.03% |
| ALEXANDER FIGUEROA3 | 1 S. FAIR OAKS AVE. PASADENA, CA 91105 | AFLAC | $7 | — | $7 | 0.03% |
| STEVE CRAIG GOLDSTEIN3 | 1 S. FAIR OAKS AVE. SUITE 200 PASADENA, CA 91105 | AFLAC | $6 | — | $6 | 0.02% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 10160 BRISTOL DR. RANCHO CUCAMONGA, CA 91737 | AFLAC | $4 | — | $4 | 0.02% |
| BRENDA MAE SANDERS3 | 2908 VALLE VISTA DR. LOS ANGELES, CA 90065 | AFLAC | $4 | — | $4 | 0.02% |
| JONA ANDREWS STOCKER3 | 26082 OHARA LN. STEVENSON RANCH, CA 91381 | AFLAC | $3 | — | $3 | 0.01% |
| CRAIG HASENBANK3 Filed as: CRAIG ANTHONY HASENBANK | 18403 COLLINS ST. UNIT C TARZANA, CA 91356 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | $2K | — | $2K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | AMERITAS LIFE INSURANCE CORP. | $1K | — | $1K | 10.00% |
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 | 132 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 132 | $709K |
| Dental | LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | 153 | $17K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 115 | $15K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 132 | $535K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 132 | $561K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 153 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.