| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNITEDHEALTHCARE INSURANCE COMPANY | $57K | $8K | $65K | 5.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $26K | $6K | $32K | 14.24% |
| PACIFIC ADVISORS LLC3 | 8383 WILSHIRE BLVD. SUITE 212 BEVERLY HILLS, CA 90211 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $839 | — | $839 | 0.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | $160 | $7K | 4.72% |
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 | 216 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 353 | $1.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 235 | $224K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 235 | $224K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 235 | $224K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 235 | $224K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 235 | $224K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 353 | $1.1M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 235 | $224K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 353 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.