| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $113K | $29 | $113K | 5.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $7K | $41K | $49K | 3.80% |
| IMA, INC.3 | 1550 17TH ST. SUITE 600 DENVER, CO 80202 | CALIFORNIA PHYSICIANS' SERVICE | $3K | $17K | $21K | 1.61% |
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $2K | $12K | $14K | 1.07% |
| IMA, INC.3 | 1550 17TH ST. SUITE 600 DENVER, CO 80202 | CALIFORNIA PHYSICIANS' SERVICE | — | $548 | $548 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $4K | $17K | 20.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $2K | $7K | 20.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $2K | $7K | 20.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $351 | — | $351 | 3.48% |
| IMA, INC.3 | 1550 17TH ST. SUITE 600 DENVER, CO 80202 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $153 | — | $153 | 1.52% |
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $101 | — | $101 | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $553 | $2K | 20.95% |
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 | 343 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 343 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 266 | $3.4M |
| Dental | CALIFORNIA PHYSICIANS' SERVICE | 133 | $1.3M |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 133 | $1.3M |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 332 | $94K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 73 | $36K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 328 | $36K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 266 | $3.4M |
| Other(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | 332 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 332 | — |
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.