| 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. | $69K | — | $69K | 4.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HEALTH NET | $7K | — | $7K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $2K | $5K | 5.33% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC. | 1000 BURNETT AVE. SUITE 440 CONCORD, CA 94520 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $20 | $4K | 4.60% |
| KATHY TRAVIS3 | 111 LA FORTUNA NEWBURY PARK, CA 91320 | AFLAC | $1K | $44 | $1K | 4.86% |
| LAURIE A. HENNESSY3 | 276 MELROSE DR. OXNARD, CA 93035 | AFLAC | $517 | $44 | $561 | 2.30% |
| MICHAEL S NOLAN3 Filed as: MICHAEL S. NOLAN | 1445 E. LOS ANGELES AVE. SUITE 208 SIMI VALLEY, CA 93065 | AFLAC | $394 | — | $394 | 1.61% |
| AMY SLOKAN3 | 541 W. GAINSBOROUGH RD. APT. 101 THOUSAND OAKS, CA 91360 | AFLAC | $250 | $18 | $268 | 1.10% |
| VIRGIL LEE WHITE3 | 1426 E. J ST. OAKDALE, CA 95361 | AFLAC | $195 | — | $195 | 0.80% |
| BRADLEY IAN WITT3 | 1621 RIDGEWOOD DR. CAMARILLO, CA 93012 | AFLAC | $148 | — | $148 | 0.61% |
| GENA G QUARANTELLO3 Filed as: GENA G. QUARANTELLO | 5030 CLOVER LN TITUSVILLE, FL 32780 | AFLAC | $114 | — | $114 | 0.47% |
| BRUCE QUARANTELLO3 | 5030 CLOVER LN TITUSVILLE, FL 32780 | AFLAC | $98 | — | $98 | 0.40% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 300 E. ESPLANADE DR. SUITE 1220 OXNARD, CA 93036 | AFLAC | $93 | — | $93 | 0.38% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D. BREDESON INSURANCE SERVICES INC. | 19043 META RD. CORNELIUS, NC 28031 | AFLAC | $93 | — | $93 | 0.38% |
| DEREK LYN KECK3 | 17809 COUNTRYSIDE CT. SALINAS, CA 93907 | AFLAC | $65 | — | $65 | 0.27% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $56 | — | $56 | 0.23% |
| JACOB BURNS INC.3 | 11637 GORHAM AVE. APT. 106 LOS ANGELES, CA 90049 | AFLAC | $22 | $18 | $40 | 0.16% |
| FALCE BENEFITS GROUP INC.3 | 191 CYPRESS LN WATSONVILLE, CA 95076 | AFLAC | $39 | — | $39 | 0.16% |
| VIRGIL LEE WHITE3 | 1426 E. J ST. OAKDALE, CA 95361 | AFLAC | $38 | — | $38 | 0.16% |
| JOSEPH RAY HARDIE3 | 909 E. PLAYA DEL NORTE DR. APT. 6011 TEMPE, AZ 85281 | AFLAC | $35 | — | $35 | 0.14% |
| ERNESTO T GONZALEZ3 Filed as: ERNESTO T. GONZALEZ | 10653 W. LEILANI DR. BOISE, ID 83709 | AFLAC | $34 | — | $34 | 0.14% |
| JACOB BURNS INC.3 | 2905 MAGNOLIA AVE. LONG BEACH, CA 90806 | AFLAC | $34 | — | $34 | 0.14% |
| VICKI L. WEAVER3 | 201 GLENWOOD CIR. APT. 34E MONTEREY, CA 93940 | AFLAC | $19 | — | $19 | 0.08% |
| GUY M. WELCH3 | 5414 MERCEDES AVE. DALLAS, TX 75206 | AFLAC | $13 | — | $13 | 0.05% |
| MAYNARD M. YOUNG3 | 20 HOBBS RD. EFFINGHAM, NH 03882 | AFLAC | $11 | — | $11 | 0.05% |
| SHELIA H. HARTMAN3 | 22801 VENTURA BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $11 | — | $11 | 0.05% |
| HORACE R WEAVER III3 Filed as: HORACE R. WEAVER III | 106 FOUNTAIN DR. SLIDELL, LA 70458 | AFLAC | $9 | — | $9 | 0.04% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 641 HIGUERA ST. SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $8 | — | $8 | 0.03% |
| SIERRA N KIRSHY3 Filed as: SIERRA N. KIRSHY | 348 DIAMOND OAKS RD. ROSEVILLE, CA 95678 | AFLAC | $8 | — | $8 | 0.03% |
| JOSEPH RAY HARDIE3 | 6000 E. EVANS AVE. SUITE 1-330 DENVER, CO 80222 | AFLAC | $7 | — | $7 | 0.03% |
| ANA MARIA BACKNER3 | 30 LA ENCINA NEWBURY PARK, CA 91320 | AFLAC | $7 | — | $7 | 0.03% |
| ERNESTO T GONZALEZ3 Filed as: ERNESTO T. GONZALEZ | 22720 CANYON VIEW DR. CORONA, CA 92883 | AFLAC | $7 | — | $7 | 0.03% |
| SHANE DAVISON3 Filed as: SHANE CRAIG DAVIISON | 3013 LARGE HOP LN ANTIOCH, TN 37013 | AFLAC | $6 | — | $6 | 0.02% |
| CHARLES D. BLOCK3 Filed as: CHARLES B. CAREY | 16215 LYLE ST. SAN LEANDRO, CA 94578 | AFLAC | $5 | — | $5 | 0.02% |
| CHUCK A. WRIGHT3 | P.O. BOX 13207 SAN LUIS OBISPO, CA 93406 | AFLAC | $5 | — | $5 | 0.02% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $4 | — | $4 | 0.02% |
| JAMES T. DUDLEY3 | 801 LITTLE MORRO CREEK RD. MORRO BAY, CA 93442 | AFLAC | $4 | — | $4 | 0.02% |
| LESTER RAY BLACKSHEAR3 | 9192 SE 168TH BOOK PL THE VILLAGES, FL 32162 | AFLAC | $4 | — | $4 | 0.02% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 2229 WHITE MIST DR. LAS VEGAS, NV 89134 | AFLAC | $3 | — | $3 | 0.01% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE ST. SUITE 220 GRANADA HILLS, CA 91344 | AFLAC | $3 | — | $3 | 0.01% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 120 PROVIDENCE TRL APT. 1200 MT. JULIET, TN 37122 | AFLAC | $2 | — | $2 | 0.01% |
| CHARLES D. BLOCK3 Filed as: CHARLES B. CAREY | 16165 LYLE ST. SAN LEANDRO, CA 94578 | AFLAC | $2 | — | $2 | 0.01% |
| JOSEPH RAY HARDIE3 | 6000 E. EVANS AVE. SUITE 1-330 DENVER, CO 80222 | AFLAC | — | — | $0 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 9.29% |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 223 | $1.5M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 361 | $112K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 26 | $168K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 159 | $42K |
| Short-term disability | AFLAC | 26 | $24K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 159 | $18K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 223 | $1.4M |
| Other(2 contracts, 2 carriers) | AFLAC | 159 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.