| 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 | BLUE CROSS OF CALIFORNIA | $122K | $2K | $124K | 5.48% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE ADMIN. | 721 S. PARKER ST. ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | — | $45K | $45K | 1.98% |
| FOUNDATION RISK PARTNERS CORP3 Filed as: FOUNDATION RISK PARTNERS CORP. | 2125 YGNACIO VALLEY RD. SUITE 200 WALNUT CREEK, CA 94598 | BLUE CROSS OF CALIFORNIA | -$13 | — | -$13 | -0.00% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $10K | $3 | $10K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 11.28% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE ADMIN. | 721 S. PARKER ST. ORANGE, CA 92868 | STANDARD INSURANCE COMPANY | — | $891 | $891 | 2.25% |
| IMA, INC.3 | 1705 17TH ST. SUITE 100 DENVER, CO 80202 | STANDARD INSURANCE COMPANY | — | $826 | $826 | 2.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 430 E. DOUGLAS AVE. SUITE 400 WICHITA, KS 672023409 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 10.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN BENEFIT ADMINISTRATORS | 721 S. PARKER ST. SUITE 300 ORANGE, CA 928684732 | PRINCIPAL LIFE INSURANCE COMPANY | — | $972 | $972 | 3.53% |
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 | 216 | 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) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 350 | $2.5M |
| Dental | BLUE CROSS OF CALIFORNIA | 350 | $2.3M |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 345 | $28K |
| Life insurance(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 350 | $2.3M |
| Long-term disability(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 350 | $2.3M |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 350 | $2.5M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 350 | $2.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 350 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.