| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | — | $69K | $69K | 5.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | — | $12K | $12K | 5.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | — | $10K | 12.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY OF | VA, INC. 11220 ASSETT LOOP, SUITE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 5.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | $3K | $9K | 13.35% |
| HAYS COMPANIES, INC.3 Filed as: HAYS GROUP INC. | 1350 BAYSHORE HIGHWAY SUITE 218 BURLINGAME, CA 94010 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | -$19 | — | -$19 | -0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 20.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY OF | VA, INC. 11220 ASSETT LOOP, SUITE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 4.81% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $2K | $52 | $2K | 4.96% |
| HAYS COMPANIES, INC.3 Filed as: THE HAYS GROUP INC. | 2 PARK PLAZA SUITE 440 IRVINE, CA 92614 | AFLAC | $579 | — | $579 | 1.65% |
| G SCOTT COOKE3 Filed as: SCOTT G. COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $446 | — | $446 | 1.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $421 | — | $421 | 1.20% |
| JONATHAN ALI HAJIMOMEN3 | 1561 E. ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $277 | $10 | $287 | 0.82% |
| PATRICIA ANN BOSCH3 | 6816 HOMAN COURT CHINO, CA 91710 | AFLAC | $225 | — | $225 | 0.64% |
| JEFFERY WAYNE GUNDERSON3 | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $163 | — | $163 | 0.47% |
| PAUL B KIRTON JR3 Filed as: PAUL B. KIRTON JR | 5520 WILSHIRE BLVD. APT. 727 LOS ANGELES, CA 90036 | AFLAC | $107 | — | $107 | 0.31% |
| ROXEANNE C. BICKHAM3 | 27254 MAIN STREET HIGHLAND, CA 92346 | AFLAC | $86 | — | $86 | 0.25% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $85 | — | $85 | 0.24% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 2001 E. FINANCIAL WAY SUITE 102 GLENDORA, CA 91741 | AFLAC | $44 | — | $44 | 0.13% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DRIVE SUITE 1150 IRVINE, CA 92612 | AFLAC | $43 | — | $43 | 0.12% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF CALIFORNIA INC. | 500 N. STATE COLLEGE BLVD. SUITE 400 ORANGE, CA 92868 | AFLAC | $40 | — | $40 | 0.11% |
| LAURA CANO3 | 718 PARK LANE CORONA, CA 92879 | AFLAC | $34 | — | $34 | 0.10% |
| JODY BAKER3 | 1561 E. ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $30 | — | $30 | 0.09% |
| STRATEGIC LIFE INSURANCE3 | SERVICES INC. 2400 MAIN STREET, SUITE 200 IRVINE, CA 92614 | AFLAC | $26 | — | $26 | 0.07% |
| RANA JANE DENNIS3 | 2001 E. FINANCIAL WAY SUITE 102 GELNDORA, CA 91741 | AFLAC | $26 | — | $26 | 0.07% |
| JAN C. CARROLL3 | 2103 CALLE OLA VERDE SAN CLEMENTE, CA 92673 | AFLAC | $23 | — | $23 | 0.07% |
| NAME NOT PROVIDED3 | 181 OLETA WAY ST. AGUSTINE, FL 32095 | AFLAC | $21 | — | $21 | 0.06% |
| NAME NOT PROVIDED3 | 1745 W. ORANGEWOOD AVENUE SUITE 212 ORANGE, CA 92868 | AFLAC | $16 | — | $16 | 0.05% |
| REBECCA ORTIZ3 | 13337 SOUTH STREET SUITE 656 CERRITOS, CA 90703 | AFLAC | $14 | — | $14 | 0.04% |
| DANIEL TYLER ADAMSON3 | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $13 | — | $13 | 0.04% |
| SHARI BOYCE3 | 4953 S. JORDAN AVENUE ONTARIO, CA 91762 | AFLAC | $13 | — | $13 | 0.04% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LANE LEXINGTON, KY 40515 | AFLAC | $12 | — | $12 | 0.03% |
| OWEN JOHNSTON3 | 1231 W. 2ND STREET SANTA ANA, CA 92703 | AFLAC | $12 | — | $12 | 0.03% |
| DOUGLAS J SUCHECKI3 Filed as: DOUGLAS J. SUCHECKI | 1224 PEACOCK AVENUE SUITE 205 COLUMBUS, GA 31906 | AFLAC | $10 | — | $10 | 0.03% |
| AARON D MCGOVERN3 Filed as: AARON D. MCGOVERN | 1794 AVENIDA REGINA SAN MARCOS, CA 92069 | AFLAC | $9 | — | $9 | 0.03% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 1615 WILSON AVENUE UPLAND, CA 91784 | AFLAC | $7 | — | $7 | 0.02% |
| MANA INSURANCE SOLUTIONS INC3 Filed as: MANA INSURANCE SOLUTIONS INC. | P.O. BOX 930 MAKAWAO, HI 96768 | AFLAC | $6 | — | $6 | 0.02% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 29 CRESTVIEW DRIVE RANCHO SANTA MARGARITA, CA 92688 | AFLAC | $6 | — | $6 | 0.02% |
| RONALD I MARTINDALE3 Filed as: RONALD I. MARTINDALE | 1281 RUNNING CREEK LANE UPLAND, CA 91784 | AFLAC | $5 | — | $5 | 0.01% |
| ANDREW R GRETHEL3 Filed as: ANDREW R. GRETHEL | 11739 HICKORY RUN COURT LOVELAND, OH 45140 | AFLAC | $3 | — | $3 | 0.01% |
| TOMMY C FLEESON3 Filed as: TOMMY C. FLEESON | 3395 MICHELSON DRIVE APT. 5155 IRVINE, CA 92612 | AFLAC | $2 | — | $2 | 0.01% |
| JEFFREY T JOHNSON3 Filed as: JEFFREY T. JOHNSON | 30766 MAINMAST DRIVE AGOURA HILLS, CA 91301 | AFLAC | $1 | — | $1 | 0.00% |
| JAMES J GRETHEL3 Filed as: JAMES J. GRETHEL | 865 CEDAR DRIVE LOVELAND, OH 45140 | AFLAC | $1 | — | $1 | 0.00% |
| KERSTIN J VANZANTEN3 Filed as: KERSTIN J. VANZANTEN | 40152 STOWE ROAD TEMECULA, CA 92591 | AFLAC | $1 | — | $1 | 0.00% |
| MARK J WOOD3 Filed as: MARK J. WOOD | 315 W. HACIENDA DRIVE CORONA, CA 92882 | AFLAC | $1 | — | $1 | 0.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY OF | VA, INC. 11220 ASSETT LOOP, SUITE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $773 | $773 | 5.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $1K | — | $1K | 10.77% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE AGENCY OF | VA, INC. 11220 ASSETT LOOP, SUITE 304 MANASSAS, VA 20109 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $772 | $772 | 6.03% |
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 | 171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 172 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | CALIFORNIA PHYSICIANS' SERVICE | 209 | $1.5M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 205 | $70K |
| Vision | EYEMED VISION CARE | 182 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $48K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $81K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $14K |
| Prescription drug(2 contracts) | CALIFORNIA PHYSICIANS' SERVICE | 209 | $1.5M |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 209 | — |
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.