| 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. | $14K | $17K | $31K | 0.77% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA HEALTH, INC. | $7K | $13K | $21K | 0.78% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 Filed as: SYNERGY ENROLLMENT & BENEFITS LLC | 3550 CAMINO DEL RIO NORTH SUITE 207 SAN DIEGO, CA 92108 | AETNA LIFE INSURANCE CO. | $43K | — | $43K | 27.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $26K | — | $26K | 17.18% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $7K | $3K | $10K | 10.12% |
| LEIGH ANN GILMORE4 | 16332 SARATOGA LANE HUNTINGTON BEACH, CA 92649 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $1K | — | $1K | 9.73% |
| VERONICA TICE4 | 2695 BENGAL TAN AVENUE NORTH LAS VEGAS, NV 89086 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $27 | — | $27 | 0.23% |
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 | 495 | 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) | 495 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 1,228 | $6.7M |
| Dental | AETNA LIFE INSURANCE CO. | 1,228 | $4.0M |
| Vision | AETNA LIFE INSURANCE CO. | 1,228 | $4.0M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 492 | $98K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 492 | $98K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 1,228 | $6.7M |
| Other(3 contracts, 3 carriers) | AETNA LIFE INSURANCE CO. | 673 | $264K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,228 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.