| 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 | AETNA LIFE INSURANCE CO. | $131K | $104 | $131K | 5.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | — | $8K | $8K | 0.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA HEALTH, INC. | $74K | — | $74K | 4.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & INSURANCE | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $9K | — | $9K | 18.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | — | $600 | $600 | 1.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | HARTFORD LIFE AND ACCIDENT | -$4K | — | -$4K | -8.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 9.76% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 6320 GREENHAVEN DRIVE CARLSBAD, CA 92009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $250 | $23 | $273 | 0.73% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $223 | $35 | $258 | 0.69% |
| ANTOINETTE MARI GARCIA3 | 1745 ORANGEWOOD AVENUE SUITE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $151 | $6 | $157 | 0.42% |
| NICHOLAS RYAN DERRICO3 | 1745 W. ORANGEWOOD AVENUE SUITE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | $10 | $96 | 0.26% |
| LUZ CASTILLO BARRIGA3 | 22019 JUAN AVENUE HAWAIIAN GARDENS, CA 90716 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $79 | $1 | $80 | 0.22% |
| DANA MARIE MOWATT3 | 23701 S. WESTERN AVENUE SUITE 112 TORRANCE, CA 90501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $51 | $4 | $55 | 0.15% |
| LAMBERT MONTALBO3 | 26197 MIRADA STREET HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | — | $42 | 0.11% |
| JONATHAN MARK DAHL3 | 1722 DIXON STREET REDONDO BEACH, CA 90278 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.09% |
| J CASTELLANOS AND ASSOCIATES INC3 Filed as: J CASTELLANOS AND ASSOCIATES INC. | 7441 FIGURA DRIVE JUSTICE, IL 60458 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.08% |
| LILIANA RIVERA3 | 25671 TONADILLA CIRCLE MORENO VALLEY, CA 92551 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.07% |
| LAURA LETICIA RENOVA3 | 2048 AUDREY HEPBURN STREET LAS VEGAS, NV 89142 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| CELIFLORA THOMPSON3 | 4454 TERRA CORVO COURT MERCED, CA 95348 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | $1 | $7 | 0.02% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| ELITESOLUTIONS LTD AND OTHER AGENTS3 Filed as: ELITESOLUTIONS LTD. | 2682 EMERALD STREET LOVELAND, CO 80537 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| ELIZABETH JEAN HEBER3 | 2511 W. SUNFLOWER AVENUE SANTA ANA, CA 92704 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| JON MALMBORG3 Filed as: JON CURTIS RICHERT | 35925 LEAH LANE YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.01% |
| GROUP SUPPLEMENTAL BENEFITS INC3 Filed as: GROUP SUPPLEMENTAL BENEFITS INC. | 1003 E. COOLEY DRIVE SUITE 211 COLTON, CA 92324 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| ELAISIUS BONNER3 | 974 ROSEFIELD LANE AURORA, IL 60504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| MAIRA MAGALI ORTIZ3 | 43642 35TH STREET EAST LANCASTER, CA 93535 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| CRYSTAL LYNN JONES3 | 16117 BUFFALO DRIVE MOORE, OK 73170 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| JESSICA RENEE GREENE3 | 630 S. INDIAN HILL BLVD. CLAREMONT, CA 91711 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | AXIS INSURANCE COMPANY | $2K | — | $2K | 9.93% |
| VERONICA TICE4 | 2695 BENGAL TAN AVENUE NORTH LAS VEGAS, NV 89086 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $521 | — | $521 | 8.13% |
| LEIGH ANN GILMORE4 | 16332 SARATOGA LANE HUNTINGTON BEACH, CA 92649 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $198 | — | $198 | 3.09% |
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 | 374 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 378 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 659 | $4.0M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 659 | $2.5M |
| Vision | AETNA LIFE INSURANCE CO. | 659 | $2.4M |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 374 | $87K |
| Prescription drug(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 659 | $4.0M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 374 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 659 | — |
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.