| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | $74K | $272 | $74K | 5.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $71K | $1K | $72K | 5.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 16.15% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$113 | $1K | $1K | 4.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 16.35% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$95 | $1K | $1K | 4.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 911076024 | VISION SERVICE PLAN | $1K | — | $1K | 5.13% |
| HEINZ SCHULMEISTER3 | 13800 CANOE BROOK DR. APT. 15F SEAL BEACH, CA 90740 | AFLAC | $908 | — | $908 | 4.59% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $308 | — | $308 | 1.56% |
| ANNETTE L. BURNS3 | 28303 BRYCE DR. CASTAIC, CA 91384 | AFLAC | $203 | $53 | $256 | 1.30% |
| JACOB BURNS INC.3 | 2905 MAGNOLIA AVE. LONG BEACH, CA 90806 | AFLAC | $193 | $12 | $205 | 1.04% |
| JOSEPH L. AGAGON3 | 3999 LEWIS AVE. LONG BEACH, CA 90807 | AFLAC | $146 | — | $146 | 0.74% |
| STEVEN R. JOHNSON3 | 2239 W. 190TH ST. TORRANCE, CA 90504 | AFLAC | $104 | — | $104 | 0.53% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 3 MITCHELL PL. UNIT 18C NEW YORK, NY 10017 | AFLAC | $65 | — | $65 | 0.33% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 2922 CORDA LN. LOS ANGELES, CA 90049 | AFLAC | $64 | — | $64 | 0.32% |
| JANELLE M ZAMORA3 Filed as: JANELLE M. ZAMORA | 421 W. BROADWAY APT. 4157 LONG BEACH, CA 90802 | AFLAC | $48 | — | $48 | 0.24% |
| GEORGE E ARBID3 Filed as: GEORGE E. ARBID | 25728 LEWIS WAY STEVENSON RANCH, CA 91381 | AFLAC | $31 | $12 | $43 | 0.22% |
| RANDI MARA RAWLINS3 | 3450 GREENFIELD AVE. LOS ANGELES, CA 90034 | AFLAC | $40 | — | $40 | 0.20% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 14747 N. NORTHSIGHT BLVD. SUITE 111-454 SCOTTSDALE, AZ 85260 | AFLAC | $38 | — | $38 | 0.19% |
| DAVID HERNANDEZ3 | 2239 W. 190TH ST. TORRANCE, CA 90504 | AFLAC | $27 | — | $27 | 0.14% |
| RUSSELL G LAKE JR3 Filed as: RUSSELL G. LAKE JR. | 26025 NEWPORT RD. SUITE A 545 MENIFEE, CA 92584 | AFLAC | $24 | — | $24 | 0.12% |
| KARI S. TAMKE3 | 45 54TH PL. APT. 4 LONG BEACH, CA 90803 | AFLAC | $23 | — | $23 | 0.12% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON JR. | 711 S. OLIVE ST. APT. 314 LOS ANGELES, CA 90014 | AFLAC | $20 | — | $20 | 0.10% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 438 PISGAH PIKE PULSAKI, TN 38478 | AFLAC | $18 | — | $18 | 0.09% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVE. LOS ANGELES, CA 90045 | AFLAC | $14 | — | $14 | 0.07% |
| KATRINA LAFATA3 | 2905 MAGNOLIA AVE. LONG BEACH, CA 90806 | AFLAC | $13 | — | $13 | 0.07% |
| RENE CASTRO3 | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $13 | — | $13 | 0.07% |
| DAVID BRYANT3 | 1925 CENTURY PARK E. SUITE 1700 LOS ANGELES, CA 90067 | AFLAC | $11 | — | $11 | 0.06% |
| USI INSURANCE SERVICES LLC3 | 201 MISSION ST. SUITE 1100 SAN FRANCISCO, CA 94105 | AFLAC | $10 | — | $10 | 0.05% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N. CLARK ST. SUITE 615 CHICAGO, IL 60654 | AFLAC | $10 | — | $10 | 0.05% |
| GARY SCOTT NELLIS3 | 10607 1/2 WOODBRIDGE ST. TOLUCA LAKE, CA 91602 | AFLAC | $8 | — | $8 | 0.04% |
| JOSEPH A NASCA3 Filed as: JOSEPH A. NASCA | 28081 W. MAPLE AVE. BARRINGTON, IL 60010 | AFLAC | $6 | — | $6 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H. WILLIS JR. | 1431 NE 55TH ST. FORT LAUDERDALE, FL 33334 | AFLAC | $2 | — | $2 | 0.01% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR. WALNUT CREEK, CA 94598 | AFLAC | $2 | — | $2 | 0.01% |
| LARA K GRANDE3 Filed as: LARA K. GRANDE | 117 MORNING MIST LN. FRANKLIN, TN 37064 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HOLMAN FAMILY COUNSELING, INC. | $104 | — | $104 | 4.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $302 | — | $302 | 16.35% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$7 | $88 | $81 | 4.39% |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 178 | $2.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 140 | $1.3M |
| Vision | VISION SERVICE PLAN | 141 | $23K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 175 | $30K |
| Short-term disability | AFLAC | 21 | $20K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 175 | $26K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 178 | $1.2M |
| Other(3 contracts, 3 carriers) | AFLAC | 175 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.