| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $82K | — | $82K | 4.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $32K | $12K | $43K | 14.07% |
| ANNETTE L. BURNS3 | 18804 MANDAN ST. UNIT 803 SANTA CLARITA, CA 91351 | AFLAC | $4K | $334 | $5K | 6.76% |
| JACOB BURNS INC.3 Filed as: JACOB M. BURNS | 12121 WILSHIRE BLVD. SUITE 1000 LOS ANGELES, CA 90025 | AFLAC | $1K | $179 | $2K | 2.40% |
| JEFFREY C. BOYKINS3 | P.O. BOX 2917 WINNETKA, CA 91396 | AFLAC | $649 | — | $649 | 0.93% |
| RENE CASTRO3 | 2581 HILLCREST ST. SIGNAL HILL, CA 90755 | AFLAC | $470 | — | $470 | 0.68% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 1502 BROADWAY UNIT 308 SANTA MONICA, CA 90404 | AFLAC | $318 | $92 | $410 | 0.59% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 12121 WILSHIRE BLVD., SUITE 1225 LOS ANGELES, CA 90025 | AFLAC | $310 | $92 | $402 | 0.58% |
| DONNA E. SINCLAIR3 | 16551 VICTORY BLVD. APT. 208 VAN NUYS, CA 91406 | AFLAC | $216 | — | $216 | 0.31% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE ST. SUITE 220 GRANDADA HILLS, CA 91344 | AFLAC | $180 | — | $180 | 0.26% |
| JENNY ROSENBAUM3 Filed as: JENNY A. ROSENBAUM | 21 TROFELLO LN ALISO VIEJO, CA 92656 | AFLAC | $165 | — | $165 | 0.24% |
| GUY M. WELCH3 | 5414 MERCEDES AVE. DALLAS, TX 75206 | AFLAC | $147 | — | $147 | 0.21% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD., SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $143 | — | $143 | 0.21% |
| ELIZABETH MICAELA VEGA3 | 11671 STRATHERN ST. NORTH HOLLYWOOD, CA 91605 | AFLAC | $85 | $39 | $124 | 0.18% |
| BILLY MCNEIL3 | 27068 CHANNEL LN VALENCIA, CA 91355 | AFLAC | $113 | — | $113 | 0.16% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $103 | — | $103 | 0.15% |
| ANA MARIA BACKNER3 | 30 LA ENCINA NEWBURY PARK, CA 91320 | AFLAC | $70 | — | $70 | 0.10% |
| MAYNARD M. YOUNG3 | 20 HOBBS ROAD EFFINGHAM, NH 03882 | AFLAC | $60 | — | $60 | 0.09% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 2001 E. FINANCIAL WAY SUITE 201 GLENDORA, CA 91741 | AFLAC | $39 | — | $39 | 0.06% |
| SHELIA H. HARTMAN3 | 22801 VENTURA BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $28 | — | $28 | 0.04% |
| DAVID JACOB HOLPER3 | 22937 ARLINGTON AVE. SUITE 102 TORRANCE, CA 90501 | AFLAC | $25 | — | $25 | 0.04% |
| DAVID M COUGHLIN3 Filed as: DAVID H. COUGHLIN | 751 HEBRON PARKWAY SUITE 220 LEWISVILLE, TX 75057 | AFLAC | $24 | — | $24 | 0.03% |
| ROXANNE C. BICKHAM3 | P.O. BOX 3554 SAN DIMAS, CA 91773 | AFLAC | $23 | — | $23 | 0.03% |
| ALL FOUR SEASONS INC.3 | 1464 MADERA ROAD N-228 SIMI VALLEY, CA 93065 | AFLAC | $19 | — | $19 | 0.03% |
| LAURA CORRAL3 | 1211 S. CATALINA ST. LOS ANGELES, CA 90006 | AFLAC | $18 | — | $18 | 0.03% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 10390 COMMERCE CENTER DR. SUITE 280 RANCHO CUCAMONGA, CA 91730 | AFLAC | $15 | — | $15 | 0.02% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBEN AVE. BELLFLOWER, CA 90706 | AFLAC | $10 | — | $10 | 0.01% |
| RONALD I MARTINDALE3 Filed as: RONALD I. MARTINDALE | 1242 N. SAN DIMAS CANYON RD SAN DIMAS, CA 91773 | AFLAC | $8 | — | $8 | 0.01% |
| JOSEPH P CALARCO3 Filed as: JOSEPH EVANS | 4721 BROOKVIEW DR. WEST DES MOINES, IA 50265 | AFLAC | $7 | — | $7 | 0.01% |
| DEBBIE L. PAPISH3 | 2907 CARRIAGE WAY WEST LINN, OR 97068 | AFLAC | $4 | — | $4 | 0.01% |
| PRAW INSURANCE SERVICES3 | 14011 VENTURA BLVD. SUITE 215W SHERMAN OAKS, CA 91423 | AFLAC | $3 | — | $3 | 0.00% |
| KAREN M HUGHES3 Filed as: KAREN N. HUGHES | 3120 NE 47TH ST. FORT LAUDERDALE, FL 33308 | AFLAC | $3 | — | $3 | 0.00% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 1201 MAIN ST., SUITE 2300 COLUMBIA, SC 29201 | AFLAC | $3 | — | $3 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $222 | $7K | 20.78% |
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 | 244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 418 | $2.0M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $307K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $307K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $307K |
| Short-term disability | AFLAC | 97 | $70K |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 253 | $408K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 418 | — |
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.