| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $105K | $1K | $106K | 3.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | — | $2K | $2K | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $30K | — | $30K | 3.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $15K | $1K | $16K | 49.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 22.54% |
| IMA, INC.4 | 1705 17TH ST. SUITE 100 DENVER, CO 80202 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | — | $1K | 11.00% |
| DIANE REEVES4 | 11956 BERNARDO PLAZA DR. UNIT 130 SAN DIEGO, CA 92128 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $588 | — | $588 | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM LIFE INSURANCE COMPANY | $4K | — | $4K | 50.28% |
| IMA, INC.4 | 1705 17TH ST. SUITE 100 DENVER, CO 80202 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $519 | — | $519 | 11.00% |
| DIANE REEVES4 | 11956 BERNARDO PLAZA DR. UNIT 130 SAN DIEGO, CA 92128 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $283 | — | $283 | 6.00% |
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 | 292 | 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) | 292 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUE CROSS OF CALIFORNIA | 396 | $3.7M |
| Dental(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 432 | $41K |
| Vision(2 contracts) | BLUE CROSS OF CALIFORNIA | 396 | $3.7M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 391 | $2.9M |
| Short-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 391 | $2.9M |
| Long-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 391 | $2.9M |
| Prescription drug(2 contracts) | BLUE CROSS OF CALIFORNIA | 396 | $3.7M |
| Other(5 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 396 | $3.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 432 | — |
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.