| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $19K | $1K | $20K | 4.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $14K | — | $14K | 3.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $4K | $7K | 10.54% |
| POLENZANI BENEFITS & INSURANCE3 | 3452 E. FOOTHILL BLVD. SUITE 514 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 9.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $137 | $2K | 6.59% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $677 | — | $677 | 7.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $544 | $33 | $577 | 7.76% |
| POLENZANI BENEFITS & INSURANCE3 | 3452 E. FOOTHILL BLVD. SUITE 514 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $571 | — | $571 | 7.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $673 | $377 | $1K | 14.15% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3579 E. FOOTHILL BLVD., SUITE 250 PASADENA, CA 91107 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $4 | — | $4 | 0.54% |
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 | 112 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 98 | $753K |
| Dental(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 160 | $76K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 160 | $68K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $37K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $39K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 32 | $349K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 116 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 160 | — |
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.