| 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. | $67K | $2K | $68K | 5.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $2K | $5K | 6.95% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC. | 1000 BURNETT AVENJUE SUITE 440 CONCORD, CA 94520 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 5.21% |
| KATHY TRAVIS3 | 276 MELROSE DRIVE OXNARD, CA 93035 | AFLAC | $484 | $21 | $505 | 4.40% |
| MICHAEL S NOLAN3 Filed as: MICHAEL S. NOLAN | 1445 E. LOS ANGELES AVENUE SUITE 208 SIMI VALLEY, CA 93065 | AFLAC | $165 | — | $165 | 1.44% |
| LAURIE A. HENNESSY3 | 276 MELROSE DRIVE OXNARD, CA 93065 | AFLAC | $129 | $21 | $150 | 1.31% |
| AMY SLOKAN3 | 541 W. GAINSBOROUGH ROAD THOUSAND OAKS, CA 91360 | AFLAC | $93 | $9 | $102 | 0.89% |
| VIRGIL LEE WHITE3 | 47 OBSIDIAN ROAD OAKDALE, CA 95361 | AFLAC | $100 | — | $100 | 0.87% |
| BRADLEY IAN WITT3 | 1621 RIDGEWOOD DRIVE CAMARILLO, CA 93012 | AFLAC | $67 | — | $67 | 0.58% |
| GENA G QUARANTELLO3 Filed as: GENA G. QUARANTELLO | 12962 E. VISTAPARK DRIVE MOORPARK, CA 93021 | AFLAC | $52 | — | $52 | 0.45% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 1139 IROLO STREET LOS ANGELES, CA 90006 | AFLAC | $41 | $9 | $50 | 0.44% |
| BRUCE QUARANTELLO3 | 412 SAND DOLLAR LANE COCOA, FL 32927 | AFLAC | $43 | — | $43 | 0.37% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D. BREDESON INSURANCE SERVICES INC. | 19043 META ROAD CORNELIUS, NC 28031 | AFLAC | $41 | — | $41 | 0.36% |
| JACOB BURNS INC.3 | 2905 MAGNOLIA AVENUE LONG BEACH, CA 90806 | AFLAC | $30 | — | $30 | 0.26% |
| DERREK LYN KECK3 | 18080 DAMIAN WAY SALINAS, CA 93907 | AFLAC | $28 | — | $28 | 0.24% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 5460 E. EL PARQUE STREET LONG BEACH, CA 90815 | AFLAC | $25 | — | $25 | 0.22% |
| FALCE BENEFITS GROUP INC.3 | 191 CYPRESS LANE WATSONVILLE, CA 95076 | AFLAC | $20 | — | $20 | 0.17% |
| JOSEPH RAY HARDIE3 | 909 E. PLAYA DEL NORTE DRIVE APT. 6011 TEMPE, AZ 85281 | AFLAC | $13 | — | $13 | 0.11% |
| VICKIE L. WEVER3 | 201 GLENWOOD CIRCLE APT. 34E MONTEREY, CA 93940 | AFLAC | $9 | — | $9 | 0.08% |
| ERNESTO T GONZALEZ3 Filed as: ERNESTO T. GONZALEZ | 10653 W. LEILANI DRIVE BOISE, ID 83709 | AFLAC | $7 | — | $7 | 0.06% |
| WORKSITE BENEFITS GROUP INC3 Filed as: WORKSITE BENEFITS CONSULTANTS | 10653 W. LEILANI DRIVE BOISE, ID 83709 | AFLAC | $6 | — | $6 | 0.05% |
| GUY M. WELCH3 | 5414 MERCEDES AVENUE DALLAS, TX 75206 | AFLAC | $6 | — | $6 | 0.05% |
| MAYNARD M. YOUNG3 | 20 HOBBS ROAD EFFINGHAM, NH 03882 | AFLAC | $5 | — | $5 | 0.04% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 641 HIGUERA STREET SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $4 | — | $4 | 0.03% |
| SIERRA N KIRSHY3 Filed as: SIERRA N. KIRSHY | 348 DIAMOND OAKS ROAD ROSEVILLE, CA 95678 | AFLAC | $4 | — | $4 | 0.03% |
| HORACE R WEAVER III3 Filed as: HORACE R. WEAVER III | 106 FOUNTAIN DRIVE SLIDELL, LA 70458 | AFLAC | $4 | — | $4 | 0.03% |
| SHANE DAVISON3 Filed as: SHANE CRAIG DAVIDSON | 3013 LARGE HOP LANE ANTIOCH, TN 37013 | AFLAC | $2 | — | $2 | 0.02% |
| CHARLES D. BLOCK3 Filed as: CHARLES B. CAREY | 16215 LYLE STREET SAN LEANDRO, CA 94578 | AFLAC | $2 | — | $2 | 0.02% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 2229 WHITE MIST DRIVE LAS VEGAS, NV 89134 | AFLAC | $1 | — | $1 | 0.01% |
| CHUCK A. WRIGHT3 | P.O. BOX 13207 SAN LUIS OBISPO, CA 93406 | AFLAC | $1 | — | $1 | 0.01% |
| LESTER RAY BLACKSHEAR3 | 9192 SE 168TH COOK PLACE THE VILLAGES, FL 32162 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES T. DUDLEY3 | 801 LITTLE MORRO CREEK ROAD MORRO BAY, CA 93442 | AFLAC | $1 | — | $1 | 0.01% |
| SHELIA H. HARTMAN3 | 22801 VENTURA BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $687 | — | $687 | 10.00% |
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 | 49 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 49 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 157 | $1.3M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 246 | $77K |
| Vision | AFLAC | 3 | $11K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 53 | $18K |
| Short-term disability | AFLAC | 3 | $11K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 53 | $7K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 157 | $1.3M |
| Other(2 contracts, 2 carriers) | AFLAC | 53 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.