| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $42K | — | $42K | 3.64% |
| FRANK CRYSTAL & CO INC3 Filed as: FRANK CRYSTAL INSURANCE SERVICES | 575 MARKET STREET SUITE 3600 SAN FRANCISCO, CA 94105 | CALIFORNIA PHYSICIANS' SERVICE | $4K | — | $4K | 0.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $14K | — | $14K | 2.28% |
| FRANK CRYSTAL & CO INC3 Filed as: FRANK CRYSTAL & CO. OF CALIF., INC. | 575 MARKET STREET, SUITTE 3600 SAN FRANCISCO, CA 941052874 | KAISER FOUNDATION HEALTH PLAN INC. | $1K | — | $1K | 0.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNION SECURITY INSURANCE COMPANY | $12K | — | $12K | 4.62% |
| FRANK CRYSTAL & CO INC3 Filed as: FRANK CRYSTAL & CO. OF CA INC. | 575 MARKET ST. SUITE 3600 SAN FRANCISCO, CA 94105 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 0.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNION SECURITY INSURANCE COMPANY | $744 | — | $744 | 49.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNION SECURITY INSURANCE COMPANY | $278 | — | $278 | 49.91% |
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 | 186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 188 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 117 | $1.8M |
| Dental | UNION SECURITY INSURANCE COMPANY | 187 | $258K |
| Vision | UNION SECURITY INSURANCE COMPANY | 187 | $258K |
| Life insurance | UNION SECURITY INSURANCE COMPANY | 187 | $258K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 187 | $258K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 100 | $1.1M |
| Other(3 contracts) | UNION SECURITY INSURANCE COMPANY | 187 | $260K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 187 | — |
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.