| 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. | $74K | $3K | $77K | 5.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $53K | $615 | $54K | 6.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $16K | — | $16K | 9.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $1K | $12K | 16.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $795 | $7K | 16.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $2K | — | $2K | 9.92% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $499 | — | $499 | 1.98% |
| 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 | $586 | — | $586 | 6.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF ALABAMA INC. | 2101 6TH AVENUE, NORTH SUITE 725 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $212 | $2K | 48.48% |
| CHRISTOPHER THOMAS SMITH3 | P.O. BOX 6650 METAIRIE, LA 70009 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $862 | $83 | $945 | 20.62% |
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 | 353 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 355 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 260 | $2.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 308 | $163K |
| Vision | EYEMED VISION CARE | 326 | $25K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 730 | $125K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 405 | $72K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 405 | $72K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 260 | $2.4M |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 730 | $129K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 730 | — |
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.