| 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. | $29K | $2K | $31K | 5.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | — | $13K | 4.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $5K | $180 | $5K | 7.90% |
| RICKY SHIH3 | 314 S. 3RD AVENUE ARCADIA, CA 91006 | AFLAC | $1K | — | $1K | 6.63% |
| MICHELE C. LEE3 | 1044 LOMA LISA LN ARCADIA, CA 91006 | AFLAC | $664 | — | $664 | 3.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $309 | — | $309 | 1.63% |
| MICHAEL R. FISHER3 | 50 W. LEMON AVENUE SUITE 2 MONROVIA, CA 91016 | AFLAC | $271 | — | $271 | 1.43% |
| KEVIN MICHAEL NAGLE3 | 32 ESPERANZA AVE. APT. F SIERRA MADRE, CA 91024 | AFLAC | $52 | — | $52 | 0.27% |
| ALICIA MARGARIT ESPINOZA3 | 170 EL DORADO ST. ARCADIA, CA 91006 | AFLAC | $37 | — | $37 | 0.20% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH A. LENZO | 701 ALBEROSKY WAY BATAVIA, IL 60510 | AFLAC | $33 | — | $33 | 0.17% |
| RATTNAK SOKHOM3 | 403 N. NEW AVENUE MONTEREY PARK, CA 91755 | AFLAC | $30 | — | $30 | 0.16% |
| DANIEL E ELLIS3 Filed as: DANIEL E. ELLIS | 201 S. MAPLE AVENUE APT. 104 OAK PARK, IL 60302 | AFLAC | $28 | — | $28 | 0.15% |
| LEANN C LEVINE3 Filed as: LEANN C. LEVINE | 1049 16TH ST. APT. 9 SANTA MONICA, CA 90403 | AFLAC | $27 | — | $27 | 0.14% |
| DINA M. KAISSAR3 | 9306 MESA VERDE DR. APT. D MONTCLAIR, CA 91763 | AFLAC | $18 | — | $18 | 0.09% |
| STEVE CRAIG GOLDSTEIN3 | 6255 VENTURA CANYON AVE. VAN NUYS, CA 91401 | AFLAC | $14 | — | $14 | 0.07% |
| GUY M. WELCH3 | 5414 MERCEDES AVE. DALLAS, TX 75206 | AFLAC | $5 | — | $5 | 0.03% |
| MICHAEL R. FISHER3 | 50 W. LEMON AVENUE SUITE 2 MONROVIA, CA 91016 | AFLAC | $4 | — | $4 | 0.02% |
| MAYNARD M. YOUNG3 | 20 HOBBS RD. EFFINGHAM, NH 03882 | AFLAC | $2 | — | $2 | 0.01% |
| VINCENT C HING3 Filed as: VINCENT C. HING | 4536 RINETTI LN. LA CANADA, CA 91011 | AFLAC | $2 | — | $2 | 0.01% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 2229 WHITE MIST DR. LAS VEGAS, NV 89134 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $161 | — | $161 | 9.98% |
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 | 164 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH, INC. | 177 | $929K |
| Dental | AETNA LIFE INSURANCE CO. | 177 | $61K |
| Vision | AETNA LIFE INSURANCE CO. | 177 | $61K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 164 | $13K |
| Prescription drug(3 contracts, 3 carriers) | AETNA HEALTH, INC. | 177 | $929K |
| Other(2 contracts, 2 carriers) | AFLAC | 164 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 177 | — |
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.