| 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 | $116K | $5K | $120K | 1.46% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $106K | $96 | $106K | 1.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | STANDARD INSURANCE COMPANY | $6K | $3K | $8K | 2.03% |
| IMA, INC.3 | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | STANDARD INSURANCE COMPANY | — | $5K | $5K | 1.25% |
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $13K | — | $13K | 16.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | DELTA DENTAL OF CALIFORNIA | $782 | — | $782 | 1.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. PASADENA, CA 91107 | ANTHEM LIFE INSURANCE COMPANY | $64 | — | $64 | 0.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | DELTA DENTAL OF CALIFORNIA | $113 | — | $113 | 1.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | DELTA DENTAL OF CALIFORNIA | $9 | — | $9 | 1.47% |
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 | 927 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 939 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 868 | $15.3M |
| Dental(3 contracts) | DELTA DENTAL OF CALIFORNIA | 340 | $61K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 868 | $7.2M |
| Life insurance(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 922 | $8.7M |
| Short-term disability(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 922 | $8.7M |
| Long-term disability(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 922 | $8.7M |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 868 | $15.3M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 922 | $8.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 922 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.