| 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. | $63K | — | $63K | 5.00% |
| INSURANCEASSIST, INC.3 | 3480 TORRANCE BLVD., SUITE 110 TORRANCE, CA 905035813 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 0.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HEALTH NET | $16K | — | $16K | 5.02% |
| INSURANCEASSIST, INC.3 | INASSIST INSURANCE SERVICES 3480 TORRANCE BLVD., SUITE 110 TORRANCE, CA 90503 | HEALTH NET | -$60 | — | -$60 | -0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 1.71% |
| INSURANCEASSIST, INC.3 Filed as: INSURANCEASSIST INC. DBA | INASSIST INSURANCE SERVICES 3480 TORRANCE BLVD., SUITE 110 TORRANCE, CA 90503 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 1.69% |
| KATHY TRAVIS3 | 111 LA FORTUNA NEWBURY PARK, CA 91320 | AFLAC | $2K | $84 | $2K | 8.39% |
| MICHAEL S NOLAN3 Filed as: MICHAEL S. NOLAN | 1445 E. LOS ANGELES AVE. SUITE 208 SIMI VALLEY, CA 93065 | AFLAC | $522 | $17 | $539 | 2.53% |
| BRADLEY IAN WITT3 | 80 WOOD RD., SUITE 202 CAMARILLO, CA 93010 | AFLAC | $296 | $17 | $313 | 1.47% |
| VIRGIL LEE WHITE3 | 1123 SOQUEL AVE. SANTA CRUZ, CA 95062 | AFLAC | $276 | — | $276 | 1.29% |
| GENA G QUARANTELLO3 Filed as: GENA G. QUARANTELLO | 12962 E. VISTAPARK DR. MOORPARK, CA 93021 | AFLAC | $148 | — | $148 | 0.69% |
| BRUCE QUARANTELLO3 | 4808 S. ELWOOD AVE. LOT 137 TULSA, OK 74107 | AFLAC | $129 | — | $129 | 0.60% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D. BREDESON INSURANCE SERVICES INC. | 641 HIGUERA ST. SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $111 | — | $111 | 0.52% |
| DERREK LYN KECK3 | 17809 COUNTRYSIDE CT. SALINAS, CA 93907 | AFLAC | $76 | — | $76 | 0.36% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 2581 HILLCREST ST. SIGNAL HILL, CA 90755 | AFLAC | $72 | — | $72 | 0.34% |
| SHELIA H. HARTMAN3 | 22801 VENTURA BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $60 | — | $60 | 0.28% |
| ANA MARIA BACKNER3 | 30 LA ENCINA NEWBURY PARK, CA 91320 | AFLAC | $50 | — | $50 | 0.23% |
| ERNESTO GONZALEZ3 Filed as: ERNESTO GONZALEZ INS. | SERVICES CORP. 1618 SANTILLAN AVE. SANTA MARIA, CA 93458 | AFLAC | $45 | — | $45 | 0.21% |
| KYLE FALCE3 | 90 GREAT OAKS BLVD. SUITE 103 SAN JOSE, CA 95119 | AFLAC | $43 | — | $43 | 0.20% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $25 | — | $25 | 0.12% |
| VICKI L. WEAVER3 | 201 GLENWOOD CIRCLE UNIT 34E MONTEREY, CA 93940 | AFLAC | $23 | — | $23 | 0.11% |
| JAMES T. DUDLEY3 | 801 LITTLE MORRO CREEK RD. MORRO BAY, CA 93442 | AFLAC | $19 | — | $19 | 0.09% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE ST. SUITE 220 GRANADA HILLS, CA 91344 | AFLAC | $18 | — | $18 | 0.08% |
| GUY M. WELCH3 | 5414 MERCEDES AVE. DALLAS, TX 75206 | AFLAC | $12 | — | $12 | 0.06% |
| MAYNARD M. YOUNG3 | 20 HOBBS ROAD EFFINGHAM, NH 03882 | AFLAC | $10 | — | $10 | 0.05% |
| LESTER RAY BLACKSHEAR3 | 8545 SW 86TH TER. OCALA, FL 34481 | AFLAC | $10 | — | $10 | 0.05% |
| HORACE R WEAVER III3 Filed as: HORACE R. WEAVER III | 106 FOUNTAIN DR. SLIDELL, LA 70458 | AFLAC | $8 | — | $8 | 0.04% |
| SIERRA N KIRSHY3 Filed as: SIERRA N. KIRSHY | 348 DIAMOND OAKS RD. ROSEVILLE, CA 95678 | AFLAC | $6 | — | $6 | 0.03% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 641 HIGUERA ST. SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $6 | — | $6 | 0.03% |
| LESTER RAY BLACKSHEAR3 | 9192 SE 168TH COOK PL. THE VILLAGES, FL 32162 | AFLAC | $6 | — | $6 | 0.03% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 120 PROVIDENCE TRL. APT. 1200 MT. JULIET, TN 37122 | AFLAC | $5 | — | $5 | 0.02% |
| CHUCK A. WRIGHT3 | P.O. BOX 13207 SAN LUIS OBISPO, CA 93406 | AFLAC | $4 | — | $4 | 0.02% |
| CHARLES D. BLOCK3 Filed as: CHARLES B. CAREY | 16165 LYLE ST. SAN LEANDRO, CA 94578 | AFLAC | $4 | — | $4 | 0.02% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 751 HEBRON PKWY. SUITE 220 LEWISVILLE, TX 75057 | AFLAC | $3 | — | $3 | 0.01% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $2 | — | $2 | 0.01% |
| ANNETTE L. BURNS3 | 28303 BRYCE DR. CASTAIC, CA 91384 | AFLAC | $2 | — | $2 | 0.01% |
| VICTOR M FLORES3 Filed as: VICTOR M. FLORES | 1815 BRENNAN CT. LANCASTER, CA 93534 | AFLAC | $2 | — | $2 | 0.01% |
| ANNETTE L. BURNS3 | 18804 MANDAN ST. UNIT 803 SANTA CLARITA, CA 91351 | AFLAC | $1 | — | $1 | 0.00% |
| ALLISON FARRIS WENDELBERGER3 | 1839 YGNACIO VALLEY RD. SUITE 393 WALNUT CREEK, CA 94598 | AFLAC | $1 | — | $1 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H. WILLIS JR. | 1431 NE 55TH ST. FORT LAUDERDALE, FL 33334 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 32.79% |
| INSURANCEASSIST, INC.3 Filed as: INSURANCEASSIST INC. | 3480 TORRANCE BLVD. SUITE 110 TORRANCE, CA 90503 | HARTFORD LIFE AND ACCIDENT | -$12K | — | -$12K | -67.61% |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 228 | $1.6M |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 119 | $137K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 32 | $347K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 175 | $39K |
| Short-term disability | AFLAC | 32 | $21K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 175 | $18K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 228 | $1.3M |
| Other(2 contracts, 2 carriers) | AFLAC | 175 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.