| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES, LLC | 3475 EAST FOOTHILL BOULEVARD SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $113K | $3K | $116K | 5.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES, LLC | PO BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $0 | $13K | 6.86% |
| VOLUNTARY BENEFIT ADVISORS3 | 2400 MAIN STREET, SUITE 200 IRVINE, CA 92614 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $776 | $4K | 2.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES, LLC | PO BOX 6030 PASADENA, CA 91102 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $665 | $0 | $665 | 7.30% |
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 | 260 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 261 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 260 | $2.2M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 156 | $193K |
| Vision | BLUE CROSS OF CALIFORNIA | 260 | $2.2M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 260 | $2.4M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 260 | $2.2M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 260 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.