| 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. | $72K | — | $72K | 4.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $57K | — | $57K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | $1K | $17K | 10.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $18K | — | $18K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $2K | — | $2K | 9.12% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $392 | — | $392 | 1.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $808 | — | $808 | 6.00% |
| CHARLES EDWARD WILLIAMS3 | 847 N. HOLLYWOOD WAY SUITE 204 BURBANK, CA 91505 | AFLAC | $329 | — | $329 | 5.09% |
| KELLIE D COOK3 Filed as: KELLIE D. COOK | 2470 STEARNS STREET SUITE 294 SIMI VALLEY, CA 93063 | AFLAC | $156 | — | $156 | 2.41% |
| SPALDING GROUP ENTERPRISES3 | 4297 KLUMP AVENUE STUDIO CITY, CA 91602 | AFLAC | $114 | — | $114 | 1.76% |
| BARBARA BARNETT3 | 1411 N. GRAND OAKS AVENUE PASADENA, CA 91104 | AFLAC | $67 | — | $67 | 1.04% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 12121 WILSHIRE BLVD. SUITE 1225 LOS ANGELES, CA 90025 | AFLAC | $43 | — | $43 | 0.67% |
| RENE CASTRO3 | 2581 HILLCREST STREET SIGNAL HILL, CA 90755 | AFLAC | $18 | — | $18 | 0.28% |
| PAUL DAVIS3 Filed as: PAUL LOUIS DAVIS | P.O. BOX 7265 VAN NUYS, CA 91409 | AFLAC | $10 | — | $10 | 0.15% |
| ALFRED RIETKERK3 | 3120 NE 47TH STREET FORT LAUDERDALE, FL 33308 | AFLAC | $10 | — | $10 | 0.15% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $7 | — | $7 | 0.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $5 | — | $5 | 8.93% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $1 | — | $1 | 1.79% |
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 | 305 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 309 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 281 | $2.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 304 | $155K |
| Vision(2 contracts) | EYEMED VISION CARE | 319 | $22K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 443 | $136K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 443 | $122K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 443 | $122K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 281 | $2.4M |
| Other(3 contracts, 3 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 443 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 443 | — |
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.