| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $48K | — | $48K | 2.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $22K | — | $22K | 9.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $1K | $8K | 17.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $4K | — | $4K | 10.00% |
| JACOB BURNS INC.3 Filed as: JACOB M. BURNS | 12121 WILSHIRE BLVD. SUITE 1000 LOS ANGELES, CA 90025 | AFLAC | $2K | $260 | $2K | 7.47% |
| LAURA CORRAL3 | 1211 S. CATALINA STREET, 1 LOS ANGELES, CA 90006 | AFLAC | $798 | — | $798 | 2.93% |
| DAVID RODRIGUEZ3 Filed as: DAVID ALEMAN | 8211 N. SIERRA VISTA AVENUE FRESNO, CA 93720 | AFLAC | $409 | $132 | $541 | 1.99% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 1502 BROADWAY UNIT 308 SANTA MONICA, CA 90404 | AFLAC | $253 | $49 | $302 | 1.11% |
| DANIEL HOSHINA3 | 1400 APPALACHIAN PLACE CHULA VISTA, CA 91915 | AFLAC | $207 | $64 | $271 | 1.00% |
| STEVEN EDGELL JR3 Filed as: STEVEN ROBERT EDGELL JR. | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $193 | $45 | $238 | 0.87% |
| LANE P MORGAN3 Filed as: LANE P. MORGAN | 672 CYNTHIA LANE SANTA CLARA, UT 84765 | AFLAC | $168 | $51 | $219 | 0.80% |
| ADAMS H. MICHAELS3 | 12121 WILSHIRE BLVD. SUITE 1225 LOS ANGELES, CA 90025 | AFLAC | $164 | $49 | $213 | 0.78% |
| JAIME PUERTA3 Filed as: JAIME I. PUERTA | 28443 SANTA CATARINA ROAD SANTA CLARITA, CA 91350 | AFLAC | $164 | $18 | $182 | 0.67% |
| ILIC-STONE INS SERVICES INC3 Filed as: ILIC STONE INSURANCE SERVICES INC. | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $104 | $45 | $149 | 0.55% |
| EDUARDO GUEDEA SR3 Filed as: EDUARDO GUEDEA SR. | 816 BROOKS AVENUE VENICE, CA 90291 | AFLAC | $108 | $10 | $118 | 0.43% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D BREDESON INSURANCE SERVICES INC. | 641 HIGUERA STREET SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $60 | $45 | $105 | 0.39% |
| BRANDON M. CROTHERS3 | 912 MISSOURI STREET SAN DIEGO, CA 92109 | AFLAC | $77 | $13 | $90 | 0.33% |
| ANNETTE L. BURNS3 | 18804 MANDAN STREET SUITE 803 SANTA CLARITA, CA 91351 | AFLAC | $71 | $6 | $77 | 0.28% |
| JD HOLDER ENTERPRISES INC3 Filed as: JD HOLDER ENTERPRISES INC. | 8220 UNIVERSITY AVENUE SUITE 200 LA MESA, CA 91942 | AFLAC | $42 | $13 | $55 | 0.20% |
| JUDSON T LAW3 Filed as: JUDSON T. LAW | 7654 WILLOW WALK LANE EAGLE MOUNTAIN, UT 84005 | AFLAC | $35 | $10 | $45 | 0.17% |
| ANDREW R GRETHEL3 Filed as: ANDREW R. GRETHEL | 600 S. HIDDEN VALLEY ROAD SUITE 150 CARLSBAD, CA 92011 | AFLAC | $22 | $13 | $35 | 0.13% |
| DAMON R STREETMAN3 Filed as: DAMON R. STREETMAN | 2961 W. MAPLE LOOP DRIVE SUITE 230 LEHI, UT 84043 | AFLAC | $13 | $10 | $23 | 0.08% |
| ALEX L. PEREZ3 | 4169 MONTEREY AVENUE BALDWIN PARK, CA 91706 | AFLAC | $22 | — | $22 | 0.08% |
| BENJAMIN JIMENEZ3 | 11546 W. CHARTER OAK ROAD EL MIRAGE, AZ 85335 | AFLAC | $21 | — | $21 | 0.08% |
| JEFFREY A KLEINMAN SR3 Filed as: JEFFREY AARON KLEINMAN SR. | 3420 E. SHEA BLVD. SUITE 168 PHOENIX, AZ 85028 | AFLAC | $4 | — | $4 | 0.01% |
| LAURIE LYNN WEST3 | 17403 WIDMORE PLACE SPRING, TX 77379 | AFLAC | $3 | — | $3 | 0.01% |
| SHAWN HOLTORF3 | 6234 WEST DEHREND DRIVE APT. 1135 GLENDALE, AZ 85308 | AFLAC | $3 | — | $3 | 0.01% |
| MICHAEL GRASS3 | 21707 KINGSLAND BLVD. SUITE 105 KATY, TX 77450 | AFLAC | $3 | — | $3 | 0.01% |
| SCOTT WEBB3 | 2355 W. PINNACLE PEAK ROAD SUITE 380 PHOENIX, AZ 85027 | AFLAC | $2 | — | $2 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $781 | $4K | 18.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $344 | $2K | 18.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVLD. SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $254 | $1K | 18.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $965 | $45 | $1K | 15.29% |
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 | 342 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 344 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 553 | $1.9M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 253 | $220K |
| Vision | VISION SERVICE PLAN | 192 | $38K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 350 | $48K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 348 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 65 | $24K |
| Other(3 contracts, 3 carriers) | AFLAC | 350 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 553 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.