| 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. | $75K | — | $75K | 5.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $45K | $660 | $46K | 6.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | — | $15K | 9.91% |
| 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 | 10.09% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $398 | — | $398 | 2.02% |
| 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 | $638 | — | $638 | 6.00% |
| CHARLES EDWARD WILLIAMS3 | 847 N. HOLLYWOOD WAY SUITE 204 BURBANK, CA 91505 | AFLAC | $271 | — | $271 | 5.04% |
| KELLIE D COOK3 Filed as: KELLIE D. COOK | 2470 STEARNS STREET SUITE 294 SIMI VALLEY, CA 93063 | AFLAC | $113 | — | $113 | 2.10% |
| SPALDING GROUP ENTERPRISES3 | 4297 KLUMP AVENUE STUDIO CITY, CA 91602 | AFLAC | $94 | — | $94 | 1.75% |
| BARBARA BARNETT3 | 1411 N. GRAND OAKS AVENUE PASADENA, CA 91104 | AFLAC | $62 | — | $62 | 1.15% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 12121 WILSHIRE BLVD. SUITE 1225 LOS ANGELES, CA 90025 | AFLAC | $37 | — | $37 | 0.69% |
| RENE CASTRO3 | 2581 HILLCREST STREET SIGNAL HILL, CA 90755 | AFLAC | $17 | — | $17 | 0.32% |
| PAUL DAVIS3 | P.O. BOX 7265 VAN NUYS, CA 91409 | AFLAC | $10 | — | $10 | 0.19% |
| ALFRED RIETKERK3 | 3120 NE 47TH STREET FORT LAUDERDALE, FL 33308 | AFLAC | $9 | — | $9 | 0.17% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $7 | — | $7 | 0.13% |
| CHRISTOPHER HAGER3 | 8201 PARK HILL DRIVE LOS ANGELES, CA 90045 | AFLAC | $2 | — | $2 | 0.04% |
| MICHAEL C WALKER3 Filed as: MICHAEL STACHOWIAK | 12121 WILSHIRE BLVD. LOS ANGELES, CA 90025 | AFLAC | $1 | — | $1 | 0.02% |
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 | 312 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 315 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 277 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 314 | $155K |
| Vision | EYEMED VISION CARE | 328 | $20K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 520 | $130K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 520 | $119K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 520 | $119K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 277 | $2.2M |
| Other(3 contracts, 3 carriers) | AMERICAN GENERAL LIFE INSURANCE COMPANY | 520 | $135K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 520 | — |
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.