| 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 | $206K | $47K | $253K | 4.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $26K | $655 | $26K | 5.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | $183 | $7K | 5.01% |
| JB CREATIVE SOLUTIONS LLC3 | 1933 JOE POOL DRIVE LITTLE ELM, TX 75068 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $846 | $140 | $986 | 6.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $984 | — | $984 | 6.69% |
| DAVID A. RACKLIFFE3 | 300 HEROIT COURT SPRING HILL, TN 37174 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $862 | $13 | $875 | 5.95% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $314 | $231 | $545 | 3.70% |
| BRIAN YERVANT AKIAN3 | P.O. BOX 17269 IRVINE, CA 92623 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $474 | $50 | $524 | 3.56% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE SUITE 1200 IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $272 | — | $272 | 1.85% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | — | $16 | 0.11% |
| CONSUMER DRIVEN BENEFITS LLC3 | 1301 DOVE STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ZURICH AMERICAN INSURANCE COMPANY | $291 | — | $291 | 15.02% |
| IMA, INC.4 Filed as: IMA CORPORATION | 1705 17TH STREET DENVER, CO 80202 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $50 | — | $50 | 7.45% |
| PHYLLIS JOY4 Filed as: PHYLLIS JOY SELZNICK BLITZ | 21115 KNIGHTS GLEN LAKE FOREST, CA 92630 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $21 | — | $21 | 3.13% |
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 | 421 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 424 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 873 | $6.3M |
| Dental | BLUE CROSS OF CALIFORNIA | 873 | $5.6M |
| Vision(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 873 | $6.3M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 873 | $5.6M |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 873 | $5.6M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 873 | $5.6M |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 873 | $6.3M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 873 | $5.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 873 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.