| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | — | $103K | $103K | 3.15% |
| IMA, INC.3 | 1550 17TH ST. SUITE 600 DENVER, CO 80202 | CALIFORNIA PHYSICIANS' SERVICE | — | $42K | $42K | 1.28% |
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | — | $28K | $28K | 0.86% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $31K | $7 | $31K | 5.08% |
| MARSH & MCLENNAN AGENCY LLC3 | LOCKBOX 740659 LOS ANGELES, CA 90074 | KAISER FOUNDATION HEALTH PLAN, INC. | -$100 | — | -$100 | -0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $25K | — | $25K | 9.17% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVE. SUITE 203 ORLANDO, FL 328013277 | METROPOLITAN LIFE INSURANCE COMPANY | $117 | — | $117 | 0.04% |
| CENTRO BENEFITS RESEARCH LLC3 | 325 N. KIRKWOOD RD. SUITE 300 KIRKWOOD, MO 631224042 | METROPOLITAN LIFE INSURANCE COMPANY | — | $10 | $10 | 0.00% |
| ANNETTE L. BURNS3 | 28303 BRYCE DRIVE CASTAIC, CA 91384 | AFLAC | $1K | — | $1K | 3.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $990 | — | $990 | 2.87% |
| MICHELLE ANN DERAS3 | 724 N. LA PALOMA AVE. ONTARIO, CA 91764 | AFLAC | $690 | $52 | $742 | 2.15% |
| JACOB BURNS INC.3 | 2905 MAGNOLIA AVE. LONG BEACH, CA 90806 | AFLAC | $497 | — | $497 | 1.44% |
| KERRIE SUZANNE WELLS3 | 5567 BERTINI WAY FONTANA, CA 92336 | AFLAC | $334 | — | $334 | 0.97% |
| RENEE SUZANNE CORSO3 | 16000 VENTURA BLVD. SUITE 1120 ENCINO, CA 91436 | AFLAC | $290 | — | $290 | 0.84% |
| AMY GONZALEZ3 | 7405 STERLING AVE. APT. C24 SAN BERNARDINO, CA 92410 | AFLAC | $251 | — | $251 | 0.73% |
| JACQUELINE VEGA3 | 9406 SWINTON AVE. NORTH HILLS, CA 91343 | AFLAC | $167 | — | $167 | 0.48% |
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $167 | — | $167 | 0.48% |
| MARSH & MCLENNAN AGENCY LLC3 | P.O. BOX 350 CONSHOHOCKEN, PA 19428 | AFLAC | $160 | — | $160 | 0.46% |
| RENEE COHN3 | 20350 VENTURA BLVD. SUITE 200 WOODLAND HILLS, CA 91364 | AFLAC | $157 | — | $157 | 0.46% |
| CORI CAMPBELL3 | 4518 186TH ST. APT. 203 REDONDO BEACH, CA 90278 | AFLAC | $125 | — | $125 | 0.36% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON JR. | 711 S. OLIVE ST. APT. 314 LOS ANGELES, CA 90014 | AFLAC | $112 | — | $112 | 0.33% |
| GEORGE E ARBID3 Filed as: GEORGE E. ARBID | 25728 LEWIS WAY STEVENSON RANCH, CA 91381 | AFLAC | $106 | — | $106 | 0.31% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 500 N. BRAND BLVD. SUITE 100 GLENDALE, CA 91203 | AFLAC | $86 | — | $86 | 0.25% |
| ANA MARIA BACKNER3 | 30 LA ENCINA NEWBURY PARK, CA 91320 | AFLAC | $73 | — | $73 | 0.21% |
| LAURA CORRAL3 | 1211 S. CATALINA ST. APT. 1 LOS ANGELES, CA 90006 | AFLAC | $73 | — | $73 | 0.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TWR WATSON INS SVCS WEST INC | 8943 W. QUAIL AVE. PEORIA, AZ 85382 | AFLAC | $67 | — | $67 | 0.19% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 438 PISGAH PIKE PULASKI, TN 38478 | AFLAC | $60 | — | $60 | 0.17% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $56 | — | $56 | 0.16% |
| MARY LOU GRAHAM3 | 1747 OFELIA WAY OXNARD, CA 93030 | AFLAC | $55 | — | $55 | 0.16% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 14747 N. NORTHSIGHT BLVD. SUITE 111-454 SCOTTSDALE, AZ 85260 | AFLAC | $45 | — | $45 | 0.13% |
| DEBORAH KIM3 Filed as: DEBORAH R.K. KIM | 3400 AVENUE OF THE ARTS APT. A216 COSTA MESA, CA 92626 | AFLAC | $42 | — | $42 | 0.12% |
| HORACIO J. LANZAS3 | 7032 BAIRD AVE. RESEDA, CA 91335 | AFLAC | $34 | — | $34 | 0.10% |
| ALFRED RIETKERK3 | 438 PISGAH PIKE PULASKI, TN 38478 | AFLAC | $32 | — | $32 | 0.09% |
| DAVID BRYANT3 | 1925 CENTURY PARK E. SUITE 1700 LOS ANGELES, CA 90067 | AFLAC | $32 | — | $32 | 0.09% |
| RENE CASTRO3 | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $29 | — | $29 | 0.08% |
| SHEM J BOSTICK3 Filed as: SHEM J. BOSTICK | 1620 S. DITMAR ST. OCEANSIDE, CA 92054 | AFLAC | $25 | — | $25 | 0.07% |
| BRIAN E KATZ3 Filed as: BRIAN E. KATZ | 1032 S. SIERRA BONITA AVE. LOS ANGELES, CA 90019 | AFLAC | $24 | — | $24 | 0.07% |
| MARSH & MCLENNAN AGENCY LLC3 | 9171 TOWNE CENTRE DR. SUITE 500 SAN DIEGO, CA 92122 | AFLAC | $20 | — | $20 | 0.06% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 3 MITCHELL PL. UNIT 18C NEW YORK, NY 10017 | AFLAC | $10 | — | $10 | 0.03% |
| ANDREINI AND COMPANY3 | 220 W. 20TH AVE. SAN MATEO, CA 94403 | AFLAC | $9 | — | $9 | 0.03% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 1139 IROLO ST. LOS ANGELES, CA 90006 | AFLAC | $9 | — | $9 | 0.03% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 2922 CORDA LN. LOS ANGELES, CA 90049 | AFLAC | $8 | — | $8 | 0.02% |
| GEOFFREY MALAIS3 | P.O. BOX 280717 NORTHRIDGE, CA 91328 | AFLAC | $8 | — | $8 | 0.02% |
| CHRISTOPHER HAGER3 | 44 COLONIAL DR. RANCHO MIRAGE, CA 92270 | AFLAC | $2 | — | $2 | 0.01% |
| GARY SCOTT NELLIS3 | 10607 1/2 WOODBRIDGE ST. TOLUCA LAKE, CA 91602 | AFLAC | $2 | — | $2 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H. WILLIS JR. | 1431 NE 55TH ST. FORT LAUDERDALE, FL 33334 | AFLAC | $2 | — | $2 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 321 N. CLARK ST. SUITE 615 CHICAGO, IL 60654 | AFLAC | $1 | — | $1 | 0.00% |
| JOSEPH A NASCA3 Filed as: JOSEPH A. NASCA | 28081 W. MAPLE AVE. BARRINGTON, IL 60010 | AFLAC | $1 | — | $1 | 0.00% |
| LARA K GRANDE3 Filed as: LARA K. GRANDE | 117 MORNING MIST LN. FRANKLIN, TN 37064 | AFLAC | $1 | — | $1 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 149 MALIBU RD. MOORESVILLE, NC 28117 | AFLAC | $1 | — | $1 | 0.00% |
| JAMES K FULATER3 Filed as: JAMES K. FULATER | 9840 57TH AVE. APT. 3M CORONA, NY 11368 | AFLAC | $394 | — | $394 | 3.70% |
| KEITH LEPACK3 | 1991 BROADWAY APT. 12B NEW YORK, NY 10023 | AFLAC | $363 | — | $363 | 3.41% |
| PATRICK RUHLE3 Filed as: PATRICK C. HARDIE | 14 WALL ST. SUITE 8C NEW YORK, NY 10005 | AFLAC | $151 | — | $151 | 1.42% |
| JACOB BURNS INC.3 Filed as: JACOB M. BURNS | 2905 MAGNOLIA AVE. LONG BEACH, CA 90806 | AFLAC | $147 | — | $147 | 1.38% |
| MARSH & MCLENNAN AGENCY LLC3 | P.O. BOX 350 SUITE 306 CONSHOHOCKEN, PA 19428 | AFLAC | $135 | — | $135 | 1.27% |
| MARILYN BARNAVE3 | 8320 141ST STREET APT. 5K JAMAICA, NY 11435 | AFLAC | $97 | — | $97 | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $626 | — | $626 | 8.60% |
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 | 282 | 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) | 282 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 250 | $3.9M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 392 | $277K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 392 | $270K |
| Life insurance(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 392 | $315K |
| Short-term disability(2 contracts) | AFLAC | 42 | $45K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 392 | $270K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 250 | $3.9M |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 392 | $315K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 392 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.