| 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. | $57K | — | $57K | 5.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $60K | $246 | $60K | 5.53% |
| HEINZ SCHULMEISTER3 | 2663 CENTINELA AVENUE UNIT 202 SANTA MONICA, CA 90405 | AFLAC | $1K | $40 | $1K | 5.03% |
| DAWN A CHRISTENSEN3 Filed as: DAWN CHRISTENSEN | 24516 APPLE STREET NEWHALL, CA 91321 | AFLAC | $389 | — | $389 | 1.37% |
| JACOB BURNS INC.3 | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $351 | $26 | $377 | 1.33% |
| JOSEPH L. AGAGON3 | 3999 LEWIS AVENUE LONG BEACH, CA 90807 | AFLAC | $145 | — | $145 | 0.51% |
| STEVEN R. JOHNSON3 | 6167 BRISTOL PARKWAY SUITE 106 CULVER CITY, CA 90203 | AFLAC | $139 | — | $139 | 0.49% |
| KATRINA LAFATA3 | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $71 | $53 | $124 | 0.44% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 3 MITCHELL PLACE UNIT 18C NEW YORK, NY 10017 | AFLAC | $98 | — | $98 | 0.35% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 2922 CORDA LANE LOS ANGELES, CA 90049 | AFLAC | $92 | — | $92 | 0.32% |
| JANELLE M ZAMORA3 Filed as: JANELLE M. ZAMORA | 421 W. BROADWAY APT. 4157 LONG BEACH, CA 90802 | AFLAC | $86 | — | $86 | 0.30% |
| RANDI MARA RAWLINS3 | 3450 GREENFIELD AVENUE LOS ANGELES, CA 90034 | AFLAC | $82 | — | $82 | 0.29% |
| BRYSTRA INSURANCE SERVICES3 Filed as: BRYSTRA INSURANCE SERVICES INC. | 1925 CENTURY PARK EAST SUITE 1700 LOS ANGELES, CA 90067 | AFLAC | $52 | $26 | $78 | 0.28% |
| DAVID HERNANDEZ3 | 1160 E. MARIPOSA AVENUE EL SEGUNDO, CA 90245 | AFLAC | $75 | — | $75 | 0.26% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $57 | — | $57 | 0.20% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON JR | 711 S. OLIVE STREET APT. 314 LOS ANGELES, CA 90014 | AFLAC | $35 | — | $35 | 0.12% |
| RUSSELL G LAKE JR3 Filed as: RUSSELL G. LAKE JR | 29309 BEACHCOMBER DRIVE SUN CITY, CA 92585 | AFLAC | $29 | — | $29 | 0.10% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVENUE LOS ANGELES, CA 90045 | AFLAC | $23 | — | $23 | 0.08% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 3120 NE 47TH STREET FORT LAUDERDALE, FL 33308 | AFLAC | $22 | — | $22 | 0.08% |
| KARI S. TAMKE3 | 45 54TH PLACE APT. 4 LONG BEACH, CA 90803 | AFLAC | $22 | — | $22 | 0.08% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 321 N. CLARK STREET SUITE 625 CHICAGO, IL 60654 | AFLAC | $19 | — | $19 | 0.07% |
| RENE CASTRO3 | 5460 E. EL PARQUE STREET LONG BEACH, CA 90815 | AFLAC | $16 | — | $16 | 0.06% |
| GARY SCOTT NELLIS3 | 10607 1/2 WOODBRIDGE STREET TOLUCA LAKE, CA 91602 | AFLAC | $7 | — | $7 | 0.02% |
| JOSEPH A NASCA3 Filed as: JOSEPH A. NASCA | 28081 W. MAPLE AVENUE BARRINGTON, IL 60010 | AFLAC | $6 | — | $6 | 0.02% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DRIVE WALNUT CREEK, CA 94598 | AFLAC | $4 | — | $4 | 0.01% |
| ANNETTE L. BURNS3 | 28303 BRYCE DRIVE CASTAIC, CA 91384 | AFLAC | $4 | — | $4 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H. WILLIS JR | 1431 NE 55TH STREET FORT LAUDERDALE, FL 33334 | AFLAC | $3 | — | $3 | 0.01% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $2 | — | $2 | 0.01% |
| LARA K GRANDE3 Filed as: LARA K. GRANDE | 117 MORNING MIST LANE FRANKLIN, TN 37064 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $517 | $5K | 16.83% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $496 | $5K | 16.85% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $759 | — | $759 | 3.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $315 | $39 | $354 | 16.85% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $84 | $84 | 4.00% |
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 | 167 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 159 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 126 | $1.1M |
| Vision | VISION SERVICE PLAN | 136 | $22K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 167 | $28K |
| Short-term disability | AFLAC | 28 | $28K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 167 | $27K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 159 | $2.2M |
| Other(3 contracts, 2 carriers) | AFLAC | 167 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 167 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.