| 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 | — | $85K | $85K | 5.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $13K | $5K | $18K | 17.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $8K | $2K | $10K | 12.66% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $1K | $115 | $2K | 3.77% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 2321ROSECRANS AVENUE SUITE 2240 EL SEGUNDO, CA 90245 | AFLAC | $502 | — | $502 | 1.22% |
| JONATHAN ALI HAJIMOMEN3 | 6540 GRAND MANAN DRIVE CYPRESS, CA 90630 | AFLAC | $418 | $45 | $463 | 1.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $454 | — | $454 | 1.10% |
| G SCOTT COOKE3 Filed as: SCOTT G. COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $443 | — | $443 | 1.07% |
| WILLA MAY ROBINSON3 | 12458 AUTUMN BREEZE STREET CERRITOS, CA 90703 | AFLAC | $324 | — | $324 | 0.79% |
| NUBIA REBECA PINA2 | 8502 W. WOODCOVE DRIVE SUITE 210 ANAHEIM, CA 92808 | AFLAC | $277 | — | $277 | 0.67% |
| KENNETH G. BARCLAY3 | 1218 VIA CANDELAS OCEANSIDE, CA 92056 | AFLAC | $275 | — | $275 | 0.67% |
| PATRICIA ANN BOSCH3 | 6816 HOMAN COURT CHINO, CA 91710 | AFLAC | $198 | — | $198 | 0.48% |
| PAUL B KIRTON JR3 Filed as: PAUL B. KIRTON JR | 5520 WILSHIRE BLVD. APT. 727 LOS ANGELES, CA 90036 | AFLAC | $98 | — | $98 | 0.24% |
| JANET TANASUGARN3 | 190 N. SINGINGWOOD STREET UNIT 3 ORANGE, CA 92869 | AFLAC | $50 | $40 | $90 | 0.22% |
| ROXANNE C. BICKHAM3 | 27254 MAIN STREET HIGHLAND, CA 92346 | AFLAC | $86 | — | $86 | 0.21% |
| CHRISTOPHER L. TANG3 | 15155 LEFFINGWELL ROAD WHITTIER, CA 90604 | AFLAC | $85 | — | $85 | 0.21% |
| KENNETH SOTHERLUND3 | 1561 E. ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $39 | $36 | $75 | 0.18% |
| DAVID SMITH3 Filed as: DAVID MATTHEW SMITH | 2001 E. FINANCIAL WAY SUITE 200 GLENDORA, CA 91741 | AFLAC | $44 | — | $44 | 0.11% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 3928 IRONBARK WAY MCKINNEY, TX 75071 | AFLAC | $44 | — | $44 | 0.11% |
| DARAVAHN THAMMA3 | 1908 W. CATALPA AVENUE ANAHEIM, CA 92801 | AFLAC | $42 | — | $42 | 0.10% |
| 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 | $35 | — | $35 | 0.08% |
| RANA JANE DENNIS3 | 9375 ARCHIBALD AVENUE SUITE 302 RANCHO CUCAMONGA, CA 91730 | AFLAC | $26 | — | $26 | 0.06% |
| JEFFERY WAYNE GUNDERSON3 | 2824 SAINT ANDREWS ROAD FAIRFIELD, CA 94534 | AFLAC | $22 | — | $22 | 0.05% |
| STRATEGIC LIFE INSURANCE3 | SERVICES INC. 1936 E. DEERE AVENUE, SUITE 120 SANTA ANA, CA 92705 | AFLAC | $22 | — | $22 | 0.05% |
| RICHARD M. ALMADA3 | 3350 SHELBY STREET SUITE 200 ONTARIO, CA 91764 | AFLAC | $21 | — | $21 | 0.05% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 108 ALSACE COURT PONTE VEDRA BEACH, FL 32082 | AFLAC | $20 | — | $20 | 0.05% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LANE LEXINGTON, KY 40515 | AFLAC | $13 | — | $13 | 0.03% |
| OWEN JOHNSTON3 | 2414 N. TUSTIN AVENUE APT. 2 SANTA ANA, CA 92705 | AFLAC | $13 | — | $13 | 0.03% |
| DANIEL TYLER ADAMSON3 | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $12 | — | $12 | 0.03% |
| REBECCA ORTIZ3 | 13337 SOUTH STREET SUITE 656 CERRITOS, CA 90703 | AFLAC | $12 | — | $12 | 0.03% |
| DOUGLAS J SUCHECKI3 Filed as: DOUGLAS J. SUCHECKI | 21 HEARTWOOD DRIVE CATAULA, GA 31804 | AFLAC | $10 | — | $10 | 0.02% |
| AARON D MCGOVERN3 Filed as: AARON D. MCGOVERN | 1794 AVENIDA REGINA SAN MARCOS, CA 92069 | AFLAC | $9 | — | $9 | 0.02% |
| NICHOLAS E VIGIL3 Filed as: NICHOLAS R D'ERRICO | 1745 W. ORANGEWOOD AVENUE SUITE 212 ORANGE, CA 92868 | AFLAC | $7 | — | $7 | 0.02% |
| SHARI BOYCE3 | 4953 S. JORDAN AVENUE ONTARIO, CA 91762 | AFLAC | $7 | — | $7 | 0.02% |
| DAVID J REESOR3 Filed as: DAVID J. REESOR | 1615 WILSON AVENUE UPLAND, CA 91784 | AFLAC | $7 | — | $7 | 0.02% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 1052 S. DREWCREST DRIVE ANAHEIM, CA 92808 | AFLAC | $6 | — | $6 | 0.01% |
| SHARI BOYCE3 | 12672 LIMONITE AVENUE SUITE 3E858 EASTVELE, CA 92880 | AFLAC | $6 | — | $6 | 0.01% |
| RONALD I MARTINDALE3 Filed as: RONALD I. MARTINDALE | 1281 RUNNING CREEK LANE UPLAND, CA 91784 | AFLAC | $5 | — | $5 | 0.01% |
| CHRIS BRANSON3 | P.O. BOX 930 MAKAWAO, HI 96768 | 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 | 0.00% |
| 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% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $2K | $9K | 25.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $932 | $932 | 5.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $811 | $811 | 5.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $1K | — | $1K | 7.66% |
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 | 208 | 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) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 188 | $1.5M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 212 | $79K |
| Vision | EYEMED VISION CARE | 198 | $14K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $51K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $107K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 206 | $18K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 188 | $1.5M |
| Other(3 contracts, 2 carriers) | AFLAC | 206 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 212 | — |
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.