| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $72K | — | $72K | 3.04% |
| PACIFIC COAST BENEFITS INSURANCE3 | SERVICES, LLC 7600 MONTEREY ST. #140 GILROY, CA 95020 | AETNA LIFE INSURANCE CO. | $31K | — | $31K | 1.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD PASADENA, CA 91107 | AETNA HEALTH, INC. | $7K | — | $7K | 2.95% |
| PACIFIC COAST BENEFITS INSURANCE3 | SERVICES, LLC 7600 MONTEREY ST. #140 FILROY, CA 95020 | AETNA HEALTH, INC. | $2K | — | $2K | 0.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | PO BOX 6030 PASADENA, CA 91102 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 7.39% |
| PACIFIC COAST BENEFITS, LLC3 Filed as: PACIFIC COAST BENEFITS INS SVC | PO BOX 1749 GILROY, CA 95021 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 5.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INSURANCE BROKERS | 3475 E FOOTHILL BLVD STA 100 PASADENA, CA 911076024 | VISION SERVICE PLAN | $1K | — | $1K | 3.43% |
| PACIFIC COAST BENEFITS, LLC3 Filed as: PACIFIC COAST BENEFIT, LLC | PO BOX 1749 GILROY, CA 950211749 | VISION SERVICE PLAN | $880 | — | $880 | 2.57% |
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 | 516 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 526 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 497 | $2.6M |
| Dental | AETNA LIFE INSURANCE CO. | 497 | $2.4M |
| Vision | VISION SERVICE PLAN | 221 | $34K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 460 | $34K |
| Other | HARTFORD LIFE AND ACCIDENT | 460 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 497 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.