| 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. | $18K | — | $18K | 2.69% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | $334 | $17K | 2.60% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURNHAM BENEFIT SERVICES | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | CALIFORNIA PHYSICIANS' SERVICE | $4K | — | $4K | 2.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $3K | — | $3K | 2.00% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 W. HILLSDALE BLVD. SUITE 201 SAN MATEO, CA 94402 | CALIFORNIA PHYSICIANS' SERVICE | $1K | — | $1K | 0.92% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | $261 | $3K | 6.43% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 W. HILLSDALE BLVD. SUITE 201 SAN MATEO, CA 94403 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 4.08% |
| VOLUNTARY BENEFIT ADVISORS3 | 2400 MAIN STREET SUITE 200 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $630 | $7K | 17.85% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 7676 N. PALM AVENUE SUITE 106 FRESNO, CA 93711 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $181 | $3K | 6.99% |
| ENROLLEASE3 Filed as: ENROLLEASE LLC - EASE CENTRAL | 1980 FESTIVAL PLAZA DRIVE SUITE 330 LAS VEGAS, NV 89135 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 3.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $167 | — | $167 | 0.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $715 | $1K | $2K | 10.65% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 6.36% |
| VOLUNTARY BENEFIT ADVISORS3 | 2400 MAIN STREET SUITE 200 IRVINE, CA 92614 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $515 | $6K | 36.56% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 7676 N. PALM AVENUE SUITE 106 FRESNO, CA 93711 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $148 | $3K | 15.24% |
| ENROLLEASE3 Filed as: ENROLLEASE LLC / EASE CENTRAL | 1980 FESTIVAL PLAZA DRIVE SUITE 330 LAS VEGAS, NV 89135 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $484 | — | $484 | 2.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $548 | $1K | $2K | 10.30% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 6.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $931 | $861 | $2K | 13.84% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 12.81% |
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 | 104 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 55 | $807K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 133 | $53K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 133 | $53K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $49K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $16K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 55 | $807K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 197 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 197 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.