| 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. | $95K | $859 | $96K | 4.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $30K | $2K | $31K | 11.49% |
| ANNETTE L. BURNS3 | 28303 BRYCE DRIVE CASTAIC, CA 91384 | AFLAC | $3K | $22 | $3K | 5.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $934 | — | $934 | 1.71% |
| JACOB BURNS INC.3 | 12121 WILSHIRE BLVD. SUITE 1000 LOS ANGELES, CA 90025 | AFLAC | $792 | $18 | $810 | 1.48% |
| JEFFREY C. BOYKINS3 | P.O. BOX 2917 WINNETKA, CA 91396 | AFLAC | $429 | — | $429 | 0.79% |
| HORACIO J. LANZAS3 | 7032 BAIRD AVENUE RESEDA, CA 91335 | AFLAC | $346 | — | $346 | 0.63% |
| KATRINA LAFATA3 | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $332 | — | $332 | 0.61% |
| BRYSTRA INSURANCE SERVICES3 Filed as: BRYSTRA INSURANCE SERVICES INC. | 11150 W. OLYMPOC BLVD. SUITE 780 LOS ANGELES, CA 90064 | AFLAC | $290 | — | $290 | 0.53% |
| RENE CASTRO3 | 5460 E. EL PARQUE STREET LONG BEACH, CA 90815 | AFLAC | $281 | — | $281 | 0.51% |
| CORI CAMPBELL3 | 4518 186TH STREET APT. 203 REDONDO BEACH, CA 90278 | AFLAC | $241 | — | $241 | 0.44% |
| GUY M. WELCH3 | 5414 MERCEDES AVENUE DALLAS, TX 75206 | AFLAC | $144 | — | $144 | 0.26% |
| LAURA CORRAL3 | 1211 S. CATALINA STREET APT. 1 LOS ANGELES, CA 90006 | AFLAC | $143 | — | $143 | 0.26% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON JR | 711 S. OLIVE STREET APT. 314 LOS ANGELES, CA 90014 | AFLAC | $135 | $7 | $142 | 0.26% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 2922 CORDA LANE LOS ANGELES, CA 90049 | AFLAC | $130 | — | $130 | 0.24% |
| GEOFFREY MALAIS3 | 16800 DEVONSHIRE STREET SUITE 220 GRANADA HILLS, CA 91344 | AFLAC | $107 | — | $107 | 0.20% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 3 MITCHELL PLACE UNIT 18C NEW YORK, NY 10017 | AFLAC | $104 | — | $104 | 0.19% |
| CORI CAMPBELL3 Filed as: CORI CAMBELL | 110 E. HILLCREST BLVD. APT. 216 INGLEWOOD, CA 90301 | AFLAC | $91 | — | $91 | 0.17% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $86 | — | $86 | 0.16% |
| ANA MARIA BACKNER3 | 30 LA ENCINA NEWBURY PARK, CA 91320 | AFLAC | $83 | — | $83 | 0.15% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE STREET NEWHALL, CA 91321 | AFLAC | $70 | — | $70 | 0.13% |
| ELIZABETH MICAELA VEGA3 | 11671 STRATHERN STREET NORTH HOLLYWOOD, CA 91605 | AFLAC | $64 | — | $64 | 0.12% |
| MAYNARD M. YOUNG3 | 20 HOBBS DRIVE EFFINGHAM, NH 03882 | AFLAC | $58 | — | $58 | 0.11% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 2220 E. ROUT 66 SUITE 215 GLENDORA, CA 91740 | AFLAC | $47 | — | $47 | 0.09% |
| BARBARA BARNETT3 | 1411 N. GRAND OAKS AVENUE PASADENA, CA 91104 | AFLAC | $41 | — | $41 | 0.08% |
| BILLY MCNEIL3 | 27068 CHANNEL LANE VALENCIA, CA 91355 | AFLAC | $36 | — | $36 | 0.07% |
| DAVID JACOB HOLPER3 | 22937 ARLINGTON AVENUE SUITE 102 TORRANCE, CA 90501 | AFLAC | $30 | — | $30 | 0.05% |
| JENNY ROSENBAUM3 Filed as: JENNY A. ROSENBAUM | 21 TROFELLO LANE ALISO VIEJO, CA 92656 | AFLAC | $27 | — | $27 | 0.05% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVENUE LOS ANGELES, CA 90045 | AFLAC | $26 | — | $26 | 0.05% |
| SHELIA H. HARTMAN3 | 22801 VENTURA BLVD. SUITE 205 WOODLAND HILLS, CA 91364 | AFLAC | $24 | — | $24 | 0.04% |
| DAVID M COUGHLIN3 Filed as: DAVID M. COUGHLIN | 10160 BRISTOL DRIVE RANCHO CUCAMONGA, CA 91737 | AFLAC | $23 | — | $23 | 0.04% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 60006 | AFLAC | $19 | — | $19 | 0.03% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 321 N. CLARK STREET SUITE 625 CHICAGO, IL 60654 | AFLAC | $15 | — | $15 | 0.03% |
| JEAN ANN SCHINDELHEIM3 | 554 DEW POINT AVENUE CARLSBAD, CA 92011 | AFLAC | $13 | — | $13 | 0.02% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBLEN AVENUE BELLFLOWER, CA 90706 | AFLAC | $12 | — | $12 | 0.02% |
| JOSEPH A NASCA3 Filed as: JOSEPH A. NASCA | 28081 W. MAPLE AVENUE BARRINGTON, IL 60010 | AFLAC | $12 | — | $12 | 0.02% |
| EDUARDO GUEDEA SR3 | 816 BROOKS AVENUE VENICE, CA 90291 | AFLAC | $10 | — | $10 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H. WILLIS JR. | 1431 NE 55TH STREET FORT LAUDERDALE, FL 33334 | AFLAC | $9 | — | $9 | 0.02% |
| JOSEPH P CALARCO3 Filed as: JOSEPH EVANS | 794 80TH STREET WEST DES MOINES, IA 50266 | AFLAC | $9 | — | $9 | 0.02% |
| DANIEL E ELLIS3 Filed as: DANIEL E. ELLIS | 377 E. BUTTERFIELD ROAD SUITE 210 LOMBARD, IL 60148 | AFLAC | $8 | — | $8 | 0.01% |
| LILY YAN3 | 5805 SEPULVEDA BLVD. SUITE 700 SHERMAN OAKS, CA 91411 | AFLAC | $7 | — | $7 | 0.01% |
| LARA K GRANDE3 Filed as: LARA K. GRANDE | 117 MORNING MIST LANE FRANKLIN, TN 37064 | AFLAC | $6 | — | $6 | 0.01% |
| GARY SCOTT NELLIS3 | 10607 1/2 WOODBRIDGE STREET TOLUCA LAKE, CA 91602 | AFLAC | $5 | — | $5 | 0.01% |
| DEBBIE L. PAPISH3 | 4714 OLD STUMP DRIVE NW GIG HARBOR, WA 98332 | AFLAC | $5 | — | $5 | 0.01% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH A. LENZO | 701 ALBEROSKY WAY BATAVIA, IL 60510 | AFLAC | $5 | — | $5 | 0.01% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DRIVE WALNUT CREEK, CA 94598 | AFLAC | $5 | — | $5 | 0.01% |
| SPALDING GROUP ENTERPRISES3 | 4297 KLUMP AVENUE STUDIO CITY, CA 91602 | AFLAC | $4 | — | $4 | 0.01% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 3120 NE 47TH STREET FORT LAUDERDALE, FL 33308 | AFLAC | $4 | — | $4 | 0.01% |
| SETH JAFFE3 Filed as: SETH L. JAFFE | 4127 E. MASSACHUSETTS STREET LONG BEACH, CA 90814 | AFLAC | $3 | — | $3 | 0.01% |
| DON C. JONES3 | 706 OAKDALE AVENUE MONROVIA, CA 91016 | AFLAC | $1 | — | $1 | 0.00% |
| LESLIE R WOODS3 Filed as: LESLIE R. WOODS | 623 SPIRIT LAKE HIGHWAY CASTLE ROCK, WA 98611 | AFLAC | $1 | — | $1 | 0.00% |
| LIVIERA MARIA RAMIREZ3 | 1107 FAIR OAKS AVENUE UNIT 882 SOUT PASADENA, CA 91030 | AFLAC | $1 | — | $1 | 0.00% |
| DAVID ANDREW PEPIN3 | 9341 FIORT BAYARD AVENUE LAS VEGAS, NV 89178 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL R. FISHER3 | 50 W. LEMON AVENUE SUITE 2 MONROVIA, CA 91016 | AFLAC | $1 | — | $1 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 728 MERCER PLACE HUNTERSVILLE, NC 28078 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 20.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $3K | $203 | $3K | 10.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 20.25% |
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 | 278 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 278 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 427 | $2.4M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 828 | $302K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 828 | $274K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 828 | $329K |
| Short-term disability | AFLAC | 57 | $55K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 427 | $2.4M |
| Other(4 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 828 | $371K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 828 | — |
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.