| 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 | $76K | — | $76K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $64K | — | $64K | 5.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HUMANA DENTAL INSURANCE COMPANY | $12K | — | $12K | 6.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $49 | $13K | 10.95% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 S. 3RD STREET, SUITE 800 COLUMBUS, OH 432155194 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 1.23% |
| BRIAN SANDERSON4 | 1503 N. GRAND OAKS AVE. PASADENA, CA 91104 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $1K | — | $1K | 22.76% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $135 | — | $135 | 2.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KANAWHA INSURANCE COMPANY | $75 | — | $75 | 2.89% |
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 | 367 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 369 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 245 | $2.7M |
| Dental | HUMANA DENTAL INSURANCE COMPANY | 353 | $192K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 177 | $1.5M |
| Life insurance(2 contracts, 2 carriers) | HUMANA DENTAL INSURANCE COMPANY | 464 | $307K |
| Short-term disability | KANAWHA INSURANCE COMPANY | 0 | $3K |
| Long-term disability(2 contracts, 2 carriers) | HUMANA DENTAL INSURANCE COMPANY | 464 | $307K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 177 | $1.5M |
| Other(4 contracts, 4 carriers) | HUMANA DENTAL INSURANCE COMPANY | 464 | $315K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 464 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.