| 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 | $31K | $7K | $38K | 5.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $5K | — | $5K | 6.96% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | — | $3K | $3K | 3.98% |
| MARIA D. WASSERMAN3 Filed as: MARIA WASSERMAN | 5465 LINDSEY LN. CYPRESS, CA 90630 | AFLAC | $570 | — | $570 | 6.33% |
| NANCY E ODOM3 Filed as: NANCY ODOM | 9330 LYNDON B. JOHNSON FWY SUITE 1125 DALLAS, TX 75243 | AFLAC | $507 | — | $507 | 5.63% |
| DAVID MARTIN GUSTAFSON3 Filed as: DAVID GUSTAFSON | P.O. BOX 2286 ADDISON, TX 75001 | AFLAC | $502 | — | $502 | 5.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $488 | — | $488 | 5.42% |
| WESLEY ROCZEY3 | 1712 HAYDEN AVENUE CORONA, CA 92881 | AFLAC | $456 | — | $456 | 5.06% |
| NICHOLAS K. GREEN3 Filed as: NICHOLAS GREEN | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $391 | — | $391 | 4.34% |
| RAYMOND HICKEM3 | 3415 COUNTRY CLUB DR. W. APT. 1039 IRVING, TX 75038 | AFLAC | $378 | $1 | $379 | 4.21% |
| CASSANDRA GREEN3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $253 | — | $253 | 2.81% |
| JACOB VAUGHAN3 | 1902 LAVACA CT. CARROLLTON, TX 75010 | AFLAC | $202 | — | $202 | 2.24% |
| KERI NORTON3 | 12472 FM 2728 TERRELL, TX 75161 | AFLAC | $182 | — | $182 | 2.02% |
| MARIA LEYVA3 | 7282 FULTON WAY STANTON, CA 90680 | AFLAC | $114 | — | $114 | 1.27% |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 115 | $650K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 99 | $71K |
| Vision | BLUE CROSS OF CALIFORNIA | 115 | $650K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 115 | $650K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 115 | $659K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.