| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIAN'S SERVICE | $36K | — | $36K | 5.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 2.93% |
| PATRICK ALVIN HOLLOWAY3 | 3006 S. VERMONT AVE. SUITE 324 LOS ANGELES, CA 90007 | AFLAC | $3K | $225 | $3K | 6.54% |
| PATRICIA GAIL LEES3 | 1124 CHURCHS CT. SUITE 210 BURBANK, CA 91501 | AFLAC | $2K | $102 | $2K | 5.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $2K | — | $2K | 4.13% |
| RHOEL T VALDEZ3 Filed as: RHOEL T. VALDEZ | 20016 BLYTHE ST. WINNETKA, CA 91306 | AFLAC | $566 | $10 | $576 | 1.32% |
| SHEM J BOSTICK3 Filed as: SHEM J. BOSTICK | 1620 S. DITMAR ST. OCEANSIDE, CA 92054 | AFLAC | $349 | $52 | $401 | 0.92% |
| DOLORES M. ROMERO3 | 2529 BRENTMOOR CT. SUWANEE, GA 30024 | AFLAC | $204 | — | $204 | 0.47% |
| ACRISURE LLC3 Filed as: SULLIVAN CURTIS MONROE INS. SVCS. | 1920 MAIN ST. SUITE 600 IRVINE, CA 92614 | AFLAC | $196 | — | $196 | 0.45% |
| ADSH INVESTMENTS3 Filed as: ADSH INVESTMENTS II INC. | 23716 BIRTCHER DR. LAKE FOREST, CA 92630 | AFLAC | $131 | — | $131 | 0.30% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 1615 WILSON AVE. UPLAND, CA 91784 | AFLAC | $111 | — | $111 | 0.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 7.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $109 | $2K | 5.47% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES | 32110 AGOURA RD. WESTLAKE VILLAGE, CA 913614026 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $18 | $2K | 4.81% |
| ENROLLEASE3 Filed as: ENROLLEASE INC. | 500 TREAT AVE. SUITE 200 SAN FRANCISCO, CA 941102068 | METROPOLITAN LIFE INSURANCE COMPANY | — | $728 | $728 | 1.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $1K | — | $1K | 8.55% |
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 | 164 | 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) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIAN'S SERVICE | 114 | $950K |
| Vision | EYEMED VISION CARE | 169 | $12K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $38K |
| Short-term disability | AFLAC | 34 | $44K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $38K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIAN'S SERVICE | 114 | $950K |
| Other(3 contracts, 3 carriers) | AFLAC | 215 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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.