| 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 | CALIFORNIA PHYSICIANS' SERVICE | $5K | $47K | $52K | 4.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $25K | $2 | $25K | 4.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 11.16% |
| IMA, INC.3 Filed as: IMA INC. | 136 E. SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | HARTFORD LIFE AND ACCIDENT | — | $604 | $604 | 1.52% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 66119 VIRGINIA BEACH, VA 23466 | HARTFORD LIFE AND ACCIDENT | — | $13 | $13 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $888 | — | $888 | 21.52% |
| IMA, INC.3 Filed as: IMA INC. | P.O. BOX 2992 WICHITA, KS 67201 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $56 | $56 | 1.36% |
| PACIFIC ADVISORS LLC3 | 4675 MACARTHUR COURT SUITE 725 NEWPORT BEACH, CA 92660 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $17 | — | $17 | 0.41% |
| USI INSURANCE SERVICES LLC4 | 21250 HAWTHORNE BLVD. SUITE 380 TORRANCE, CA 90503 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $83 | — | $83 | 8.25% |
| IMA, INC.4 Filed as: IMA INC. | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $29 | — | $29 | 2.88% |
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 | 143 | 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) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 139 | $1.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 19 | $4K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 19 | $4K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 150 | $40K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 150 | $40K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 139 | $1.7M |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 150 | $45K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 150 | — |
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."
No prospect flags tripped on this filing.