| 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 | BLUE CROSS OF CALIFORNIA | $73K | $2K | $74K | 5.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $10K | — | $10K | 3.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $18K | — | $18K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | — | $2K | 3.05% |
| KATHY DUFFY INSURANCE SERVICES3 | 10442 ORMOND ST. SHADOW HILLS, CA 91040 | ALFAC | $1K | $61 | $1K | 5.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | ALFAC | $822 | $217 | $1K | 5.12% |
| VICKY H KRESINSKE3 Filed as: VICKY H. KRESINSKE | P.O. BOX 55322 VIRGINIA BEACH, VA 23471 | ALFAC | $423 | — | $423 | 2.08% |
| DENNY P. TWIGG3 | 16800 DEVONSHIRE ST., SUITE 220 GRANADA HILLS, CA 91344 | ALFAC | $338 | — | $338 | 1.66% |
| ELIZABETH A LENZO3 Filed as: ELIZABETH A. LENZO | 265 W. NAOMI AVE. ARCADIA, CA 91007 | ALFAC | $302 | $10 | $312 | 1.54% |
| KHACHATOUR MANOUKIAN3 Filed as: KHACHATOUR CHRIS MANOUKIAN | 221 N. BELMONT STREET 7 GLENDALE, CA 91206 | ALFAC | $270 | — | $270 | 1.33% |
| BARBARA A KROLL3 Filed as: BARBARA A. KROLL | 41701 KENILWORTH LANE NOVI, MI 48377 | ALFAC | $250 | — | $250 | 1.23% |
| PAUL A SCOTT3 Filed as: PAUL A. SCOTT | 2026 N. RIVERSIDE AVENUE SUITE C 240 RIALTO, CA 92377 | ALFAC | $239 | — | $239 | 1.18% |
| TWILA D SHOWALTER3 Filed as: TWILA D. SHOWALTER | 2515 E. MARKET ST. SUITE E HARRISBURG, VA 22801 | ALFAC | $227 | — | $227 | 1.12% |
| DAVID HERNANDEZ3 | 3848 W. CARSON ST. SUITE 110 TORRANCE, CA 90503 | ALFAC | $162 | $61 | $223 | 1.10% |
| DEBORAH H HALL3 Filed as: DEBORAH H. HALL | 105 LONG LEAF PL MADISON, MS 39110 | ALFAC | $113 | — | $113 | 0.56% |
| STEVEN R. JOHNSON3 | 3848 W. CARSON ST. SUITE 110 TORRANCE, CA 90503 | ALFAC | $86 | $10 | $96 | 0.47% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 12121 WILSHIRE BLVD., SUITE 1225 LOS ANGELES, CA 90025 | ALFAC | $61 | $20 | $81 | 0.40% |
| SHAWN K STEPHENS3 Filed as: SHAWN K. STEPHENS | 515 S. FRY RD., SUITE A KATY, TX 77450 | ALFAC | $68 | — | $68 | 0.33% |
| LARRY E KESSELRING3 Filed as: LARRY E. KESSELRING | 9880 E. GRAND RIVER AVE. SUITE 106 BRIGHTON, MI 48116 | ALFAC | $66 | — | $66 | 0.32% |
| KATHLEEN A. DUFFY INSURANCE SERVICE3 Filed as: KATHLEEN A. DUFFY-LARSON | 10442 ORMOND ST. SHADOW HILLS, CA 91010 | ALFAC | $52 | — | $52 | 0.26% |
| DAVID N MORGAN3 Filed as: DAVID N. MORGAN | 906 MERCHANT LEE PL MANAKIN SABOT, VA 23103 | ALFAC | $45 | — | $45 | 0.22% |
| SHAUN M KLUG3 Filed as: SHAUN M. KLUG | 9868 HIGH MEADOW DR. YPSILANTI, MI 48198 | ALFAC | $42 | — | $42 | 0.21% |
| LARRY W SHOWALTER3 Filed as: LARRY W. SHOWALTER | 2515 EAST MARKET ST. SUITE E HARRISONBURG, VA 22801 | ALFAC | $36 | — | $36 | 0.18% |
| LINDA W OLGUIN3 Filed as: LINDA M. DUNFEE | 900-904 LIBERTY PLACE SICKLERVILLE, NJ 08081 | ALFAC | $21 | — | $21 | 0.10% |
| COURTNEY RYAN YURCZYK3 | 701 N. 2ND ST. APT. 602 MINNEAPOLIS, MN 55401 | ALFAC | $17 | — | $17 | 0.08% |
| JANET S. RENO3 | P.O. BOX 1144 CYPRESS, TX 77410 | ALFAC | $13 | — | $13 | 0.06% |
| MARY L SIMMONS3 Filed as: MARY L. SIMMONS | 84 BREEZEWOOD DR. STAUNTON, VA 24401 | ALFAC | $13 | — | $13 | 0.06% |
| THERESA NETTO PHILLIPS3 Filed as: THERESA V. REDDING | 71 COUNTRY CLUB DR. BLOOMINGDALE, IL 60108 | ALFAC | $12 | — | $12 | 0.06% |
| MICHAEL BUTTERFIELD3 | 3120 FIRE RD., SUITE B102 EGG HARBOR TOWNSHIP, NJ 08234 | ALFAC | $12 | — | $12 | 0.06% |
| MICHELLE C. LEE3 | 1044 LOMA LISA LN ARCADIA, CA 91006 | ALFAC | $11 | — | $11 | 0.05% |
| MIKE YURCZYK3 | 901 MARQUETTE AVE. SUITE 1500 MINNEAPOLIS, MN 55402 | ALFAC | $5 | — | $5 | 0.02% |
| MARIO SILVA3 Filed as: MARIO D. SILVA | 14718 PLANTATION OAK DR. HOUSTON, TX 77068 | ALFAC | $3 | — | $3 | 0.01% |
| TRUDY MARCELLINO3 | 14718 PLANTATION OAK DR. HOUSTON, TX 77068 | ALFAC | $2 | — | $2 | 0.01% |
| ALBERT SHUST3 | 200 CENTENNIAL AVE. SUITE 105 PISCATAWAY, NJ 08854 | ALFAC | $2 | — | $2 | 0.01% |
| MICHAEL GRASS3 | 21707 KINGSLAND BLVD., SUITE 105 KATY, TX 77450 | ALFAC | $1 | — | $1 | 0.00% |
| MARK D BARBIER3 Filed as: MARK D. BARBIER | 802 DEER TRAIL LN OAK BROOK, IL 60523 | ALFAC | $1 | — | $1 | 0.00% |
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 | 204 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 204 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 204 | $1.6M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 158 | $176K |
| Vision | BLUE CROSS OF CALIFORNIA | 204 | $1.3M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 204 | $1.3M |
| Short-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 204 | $1.3M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 204 | $1.3M |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 53 | $372K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 204 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.