| 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 | $147K | $14K | $162K | 7.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UPMC HEALTH OPTIONS | $9K | — | $9K | 2.77% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC. | 1420 5TH AVE. SUITE 1500 SEATTLE, WA 98101 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $686 | — | $686 | 5.63% |
| LAWRENCE A. MANTELL & ASSOCIATES3 | INC. 16055 VENTURA BLVD., SUITE 1100 ENCINO, CA 91436 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $631 | — | $631 | 5.18% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC. | ATT. ERICA MENDEZ 1301 DOVE ST., SUITE 200 NEWPORT BEACH, CA 92660 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $133 | $133 | 1.09% |
| WANGLIN, RONALD, CHASE3 | P.O. BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | $143 | $13 | $156 | 3.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UPMC HEALTH OPTIONS | $60 | — | $60 | 2.40% |
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 | 231 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 239 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 396 | $2.4M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 396 | $2.0M |
| Vision | BLUE CROSS OF CALIFORNIA | 396 | $2.0M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 396 | $2.0M |
| Short-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 396 | $2.1M |
| Long-term disability(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 396 | $2.1M |
| Prescription drug(2 contracts) | UPMC HEALTH OPTIONS | 63 | $332K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 396 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 396 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.