| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $80K | $3K | $83K | 6.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $13 | $931 | $944 | 0.07% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $17K | $5 | $17K | 5.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | STANDARD INSURANCE COMPANY | $12K | — | $12K | 14.85% |
| IMA, INC.3 | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | STANDARD INSURANCE COMPANY | — | $2K | $2K | 2.12% |
| PATRICIA SWANSON4 | 579 W. LEMON AVE. MONROVIA, CA 91016 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $315 | — | $315 | 6.91% |
| DEBRA OTTEN4 Filed as: DEBRA L. OTTEN | 1808 KINGS LAKE BLVD. APT 104 NAPLES, FL 34112 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $90 | — | $90 | 1.97% |
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 | 217 | 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) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 279 | $1.7M |
| Dental | BLUE CROSS OF CALIFORNIA | 279 | $1.3M |
| Vision | BLUE CROSS OF CALIFORNIA | 279 | $1.3M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 279 | $1.4M |
| Short-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 279 | $1.4M |
| Long-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 279 | $1.4M |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 279 | $1.7M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 279 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 279 | — |
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.