| 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. | $39K | — | $39K | 4.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $11K | $21K | 22.56% |
| ANNETTE L. BURNS3 | 28303 BRYCE DR. CASTAIC, CA 91384 | AFLAC | $881 | $76 | $957 | 7.19% |
| JACOB BURNS INC.3 Filed as: JACOB M. BURNS | 12121 WILSHIRE BLVD. SUITE 1000 LOS ANGELES, CA 90025 | AFLAC | $308 | $30 | $338 | 2.54% |
| LAURA CORRAL3 | 1211 S. CATALINA ST. APT. 1 LOS ANGELES, CA 90006 | AFLAC | $118 | $67 | $185 | 1.39% |
| JEFFREY C. BOYKINS3 | P.O. BOX 2917 WINNETKA, CA 91396 | AFLAC | $110 | — | $110 | 0.83% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON JR. | 711 S. OLIVE ST. APT. 314 LOS ANGELES, CA 90014 | AFLAC | $73 | $30 | $103 | 0.77% |
| RENE CASTRO3 | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $71 | — | $71 | 0.53% |
| HORACIO J. LANZAS3 | 7032 BAIRD AVE. RESEDA, CA 91335 | AFLAC | $52 | $9 | $61 | 0.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $51 | — | $51 | 0.38% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 3 MITCHELL PLACE UNIT 18C NEW YORK, NY 10017 | AFLAC | $42 | — | $42 | 0.32% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 12121 WILSHIRE BLVD. SUITE 1225 LOS ANGELES, CA 90025 | AFLAC | $42 | — | $42 | 0.32% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE ST. SUITE 220 GRANADA HILLS, CA 91344 | AFLAC | $34 | — | $34 | 0.26% |
| GUY M. WELCH3 | 5414 MERCEDES AVE. DALLAS, TX 75206 | AFLAC | $27 | — | $27 | 0.20% |
| JEAN ANN SCHINDELHEIM3 | 554 DEW POINT AVE. CARLSBAD, CA 92011 | AFLAC | $25 | — | $25 | 0.19% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $25 | — | $25 | 0.19% |
| JENNY ROSENBAUM3 Filed as: JENNY A. ROSENBAUM | 21 TROFELLO LN. ALISO VIEJO, CA 92656 | AFLAC | $21 | — | $21 | 0.16% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $20 | — | $20 | 0.15% |
| ANA MARIA BACKNER3 | 30 LA ENCINA NEWBURY PARK, CA 91320 | AFLAC | $19 | — | $19 | 0.14% |
| BILLY MCNEIL3 | 27068 CHANNEL LANE VALENCIA, CA 91355 | AFLAC | $15 | — | $15 | 0.11% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 2220 E. ROUTE 66 SUITE 215 GLENDORA, CA 91740 | AFLAC | $11 | — | $11 | 0.08% |
| MAYNARD M. YOUNG3 | 20 HOBBS ROAD EFFINGHAM, NH 03882 | AFLAC | $11 | — | $11 | 0.08% |
| ELIZABETH MICAELA VEGA3 | 11671 STRATHERN ST. NORTH HOLLYWOOD, CA 91605 | AFLAC | $10 | — | $10 | 0.08% |
| CHRISTOPHER HAGER3 | 8201 PARK HILL DR. LOS ANGELES, CA 90045 | AFLAC | $9 | — | $9 | 0.07% |
| NEVIN VACHEL MCFARLAND3 | 11620 WILSHIRE BLVD. SUITE 210 LOS ANGELES, CA 90025 | AFLAC | $7 | — | $7 | 0.05% |
| BARBARA BARNETT3 | 1411 N. GRAND OAKS AVE. PASADENA, CA 91104 | AFLAC | $6 | — | $6 | 0.05% |
| SHELIA H. HARTMAN3 | 22801 VENTURA BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $6 | — | $6 | 0.05% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 12121 WILSHIRE BLVD. LOS ANGELES, CA 90025 | AFLAC | $6 | — | $6 | 0.05% |
| DAVID JACOB HOLPER3 Filed as: DAVID JOCOB HOLPER | 22937 ARLINGTON AVE. SUITE 102 TORRANCE, CA 90501 | AFLAC | $5 | — | $5 | 0.04% |
| ROXANNE C. BICKHAM3 | 10350 BASELINE RD. SPC 40 RANCHO CUCAMONGA, CA 91701 | AFLAC | $5 | — | $5 | 0.04% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 751 HEBRON PKWY. SUITE 220 LEWISVILLE, TX 75057 | AFLAC | $4 | — | $4 | 0.03% |
| DONNA E. SINCLAIR3 | 16551 VICTORY BLVD. APT. 208 VAN NUYS, CA 91406 | AFLAC | $4 | — | $4 | 0.03% |
| JOSEPH A NASCA3 Filed as: JOSEPH A. NASCA | 28081 W. MAPLE AVE. BARRINGTON, IL 60010 | AFLAC | $3 | — | $3 | 0.02% |
| SETH JAFFE3 | 4127 E. MASSACHUSETTS ST. LONG BEACH, CA 90814 | AFLAC | $3 | — | $3 | 0.02% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 2220 E. ROUTE 66 SUITE 215 GLENDORA, CA 91740 | AFLAC | $3 | — | $3 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H. WILLIS JR. | 1431 NE 55TH ST. FORT LAUDERDALE, FL 33334 | AFLAC | $3 | — | $3 | 0.02% |
| LESLIE R WOODS3 Filed as: LESLIE R. WOODS | 623 SPIRIT LAKE HWY CASTLE ROCK, WA 98611 | AFLAC | $3 | — | $3 | 0.02% |
| ALL FOUR SEASONS INC.3 | 1464 MADERA ROAD N-228 SIMI VALLEY, CA 93065 | AFLAC | $2 | — | $2 | 0.02% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBLEN AVE. BELLFLOWER, CA 90706 | AFLAC | $2 | — | $2 | 0.02% |
| JOSEPH P CALARCO3 Filed as: JOSEPH EVANS | 4721 BROOKVIEW DR. WEST DES MOINES, IA 50265 | AFLAC | $2 | — | $2 | 0.02% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $2 | — | $2 | 0.02% |
| DON C. JONES3 | 706 OAKDALE AVE. MONROVIA, CA 91016 | AFLAC | $2 | — | $2 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $2 | — | $2 | 0.02% |
| ALLISON FARRIS WENDELBERGER3 | 18396 YGNACIO VALLEY RD. SUITE 393 WALNUT CREEK, CA 94598 | AFLAC | $2 | — | $2 | 0.02% |
| GARY SCOTT NELLIS3 | 10607 1/2 WOODBRIDGE ST. TOLUCA LAKE, CA 91602 | AFLAC | $2 | — | $2 | 0.02% |
| RONALD I MARTINDALE3 Filed as: RONALD I. MARTINDALE | 1242 N. SAN DIMAS CANYON RD. SAN DIMAS, CA 91773 | AFLAC | $2 | — | $2 | 0.02% |
| LARA K GRANDE3 Filed as: LARA K. GRANDE | 1022 WESTHAVEN BLVD. FRANKLIN, TN 37064 | AFLAC | $1 | — | $1 | 0.01% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $1 | — | $1 | 0.01% |
| DEBBIE L. PAPISH3 | 2907 CARRIAGE WAY WEST LINN, OR 97068 | AFLAC | $1 | — | $1 | 0.01% |
| LILY YAN3 | 5805 SEPULVEDA BLVD. SUITE 700 SHERMAN OAKS, CA 91411 | AFLAC | $1 | — | $1 | 0.01% |
| DAVID ANDREW PEPIN3 | 10000 NORTH 31ST AVE. PHOENIX, AZ 85051 | AFLAC | $1 | — | $1 | 0.01% |
| PRAW INSURANCE SERVICES3 | 14011 VENTURA BLVD. SUITE 215W SHERMAN OAKS, CA 91423 | AFLAC | $1 | — | $1 | 0.01% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 3120 NE 47TH ST. FORT LAUDERDALE, FL 33308 | AFLAC | $1 | — | $1 | 0.01% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH A. LENZO | 1840 VIA DEL REY SOUTH PASADENA, CA 91030 | AFLAC | $1 | — | $1 | 0.01% |
| DANIEL E ELLIS3 Filed as: DANIEL E. ELLIS | 317 MARKET ST. ROCKFORD, IL 61107 | AFLAC | $1 | — | $1 | 0.01% |
| DANIEL E ELLIS3 Filed as: DANIEL E. ELLIS | 377 E. BUTTERFIELD RD. SUITE 210 LOMBARD, IL 60148 | AFLAC | $1 | — | $1 | 0.01% |
| DOUGLAS MEIER3 | 14 WALL ST. SUITE 8C NEW YORK, NY 10005 | AFLAC | $1 | — | $1 | 0.01% |
| SPALDING GROUP ENTERPRISES3 | 4297 KLUMP AVE. STUDIO CITY, CA 91602 | AFLAC | $1 | — | $1 | 0.01% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 1201 MAIN ST. SUITE 2300 COLUMBIA, SC 29201 | AFLAC | $1 | — | $1 | 0.01% |
| MARSHALL CHARLES MCDONALD3 | 415 DAVIDSON GATEWAY DR. APT. 7 DAVIDSON, NC 28036 | AFLAC | $1 | — | $1 | 0.01% |
| TODD J BURKE CORP3 Filed as: TODD J. BURKE | 1 SEAPORT PLAZA 23RD FLOOR NEW YORK, NY 10038 | AFLAC | $1 | — | $1 | 0.01% |
| LIVIER MARIA RAMIREZ3 | 1107 FAIR OAK AVE. UNIT 882 SOUTH PASADENA, CA 91030 | AFLAC | $1 | — | $1 | 0.01% |
| SHANE DAVISON3 Filed as: SHANE CRAIG DAVIDSON | 120 PROVIDENCE TRL. APT. 1200 MT. JULIET, TN 37122 | AFLAC | $1 | — | $1 | 0.01% |
| KENNETH C MEIER CORP3 Filed as: KENNETH C. MEIER | 401 FRANKLIN AVE. SUITE 312 GARDEN CITY, NY 11530 | AFLAC | $1 | — | $1 | 0.01% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 6631 FOX RIDGE CIRCLE DAVIDSON, NC 28036 | AFLAC | $1 | — | $1 | 0.01% |
| MICHAEL R. FISHER3 | 3201 WILSHIRE BLVD. SUITE 102 SANTA MONICA, CA 90403 | AFLAC | $1 | — | $1 | 0.01% |
| JOANNA G MATHERLY3 Filed as: JOANNA G. MATHERLY | 2000 GLEN ECHO RD. SUITE 204 NASHVILLE, TN 37215 | AFLAC | $1 | — | $1 | 0.01% |
| TODD V MASON3 Filed as: TODD V. MASON | 6164 LAWRENCE ST. CYPRESS, CA 90630 | AFLAC | $1 | — | $1 | 0.01% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 110 SE 6TH ST. SUITE 1700 FT. LAUDERDALE, FL 33301 | AFLAC | $1 | — | $1 | 0.01% |
| ANNE MARIE HUBBARD3 | 5138 RESIDENCIA NEWPORT BEACH, CA 92660 | AFLAC | $1 | — | $1 | 0.01% |
| BENITO A ROTONDI II INC3 Filed as: BENITO A. ROTONDI II | 401 FRANKLIN AVE. SUITE 312 GARDEN CITY, NY 11530 | AFLAC | $1 | — | $1 | 0.01% |
| KARLA M. TOMAS3 | 516 S. VIA MONTANA BURBANK, CA 91501 | AFLAC | $1 | — | $1 | 0.01% |
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 | 256 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 446 | $787K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $92K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $92K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $105K |
| Short-term disability | AFLAC | 102 | $13K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 260 | $105K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 446 | — |
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.