| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN INC | $25K | $12 | $25K | 4.16% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS. SERVICES, LLC | 6320 CANOGA AVENUE, SUITE 1200 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN INC | $5K | $1 | $5K | 0.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE COMPANY | $12K | $293 | $12K | 2.59% |
| DANONE SIMPSON INSURANCE SERVICES3 | 5550 TOPANGA CANYON BOULEVARD SUITE 310 WOODLAND HILLS, CA 91367 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.23% |
| VENBROOK INSURANCE SERVICES3 | 6320 CANOGA AVENUE, 12TH FLOOR WOODLAND HILLS, CA 91637 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD SUITE 100 PASADENA, CA 91107 | AETNA HEALTH, INC. | $6K | $0 | $6K | 2.42% |
| VENBROOK INSURANCE SERVICES3 | 6320 CANOGA AVENUE, 12TH FLOOR WOODLAND HILLS, CA 91367 | AETNA HEALTH, INC. | $573 | $0 | $573 | 0.24% |
| DANONE SIMPSON INSURANCE SERVICES3 | 5550 TOPANGA CANYON BOULEVARD SUITE 310 WOODLAND HILLS, CA 91367 | AETNA HEALTH, INC. | $557 | $0 | $557 | 0.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 3.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD SUITE 100 PASADENA, CA 91107 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.80% |
| BENEFITS AMERICA INS. SVCS., LLC3 Filed as: BENEFITS AMERICA INS. SERVICES, LLC | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $475 | $0 | $475 | 0.40% |
| MJ INSURANCE3 Filed as: CRYSTAL IBC, LLC AND VARIOUS AGENTS | ONE FINANCIAL SQUARE, 32ND FLOOR NEW YORK, NY 10005 | AFLAC | $3K | $6 | $3K | 6.04% |
| MICHELLE ANN DERAS3 | 5805 SEPULVEDA BOULEVARD, SUITE 700 SHERMAN OAKS, CA 91411 | AFLAC | $2K | $61 | $2K | 4.81% |
| BETTY MURDOCK3 | 7216 TESSERA PARKWAY LAGO VISTA, TX 78645 | AFLAC | $1K | $15 | $1K | 2.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AFLAC | $645 | $0 | $645 | 1.24% |
| STANTON HUNTON3 Filed as: STANTON C. HUNTON | 2516 VIA TEJON, SUITE 307 PALOS VERDES ESTATES, CA 90274 | AFLAC | $637 | $0 | $637 | 1.23% |
| RENEE SUZANNE CORSO3 | 5805 SEPULVEDA BOULEVARD, SUITE 700 SHERMAN OAKS, CA 91411 | AFLAC | $534 | $12 | $546 | 1.05% |
| PAUL GALLEGOS3 | 10519 SHOSHONE AVENUE GRANADA HILLS, CA 91344 | AFLAC | $533 | $12 | $545 | 1.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | CALIFORNIA DENTAL NETWORK, INC. | $703 | $0 | $703 | 8.46% |
| VENBROOK INSURANCE SERVICES3 | 6320 CANOGA AVENUE, 12TH FLOOR WOODLANDS HILLS, CA 91367 | CALIFORNIA DENTAL NETWORK, INC. | $129 | $0 | $129 | 1.55% |
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 | 163 | 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) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 108 | $1.3M |
| Dental(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 163 | $127K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 163 | $119K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 163 | $119K |
| Short-term disability | AFLAC | 64 | $52K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 163 | $119K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 108 | $1.3M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 163 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.