| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $30K | $19 | $30K | 3.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $17K | — | $17K | 2.64% |
| ENROLLEASE3 Filed as: ENROLLEASE INC. | 1980 FESTIVAL PLAZA DR. SUITE 810 LAS VEGAS, NV 891352958 | METROPOLITAN LIFE INSURANCE COMPANY | — | $5K | $5K | 5.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 5.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $556 | $6K | 11.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $195 | $3K | 14.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $2K | — | $2K | 10.72% |
| ENROLLEASE3 Filed as: ENROLLEASE INC. | 1980 FESTIVAL PLAZA DRIVE SUITE 810 LAS VEGAS, NV 891352958 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $880 | $880 | 5.35% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 12.16% |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 137 | $1.5M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 197 | $109K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 197 | $93K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $65K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $61K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 137 | $1.5M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 146 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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."
No prospect flags tripped on this filing.