| 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. | $67K | $7K | $73K | 3.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $25K | — | $25K | 9.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $897 | $8K | 15.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $4K | — | $4K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $542 | $5K | 16.92% |
| JACOB BURNS INC.3 Filed as: JACOB M. BURNS | 12121 WILSHIRE BLVD. SUITE 1000 LOS ANGELES, CA 90025 | AFLAC | $1K | $38 | $1K | 6.48% |
| HORACIO J. LANZAS3 | 7032 BAIRD AVENUE RESEDA, CA 91335 | AFLAC | $151 | $16 | $167 | 0.98% |
| OLENA K SHEA3 Filed as: OLENA K. SHEA | 3 MITCHELL PLACE UNIT 18C NEW YORK, NY 10017 | AFLAC | $116 | — | $116 | 0.68% |
| JAIME PUERTA3 Filed as: JAIME I. PUERTA | 28443 SANTA CATARINA ROAD SANTA CLARITA, CA 91350 | AFLAC | $111 | — | $111 | 0.65% |
| LANE P MORGAN3 Filed as: LANE P. MORGAN | 672 CYNTHIA LANE SANTA CLARA, UT 84765 | AFLAC | $96 | — | $96 | 0.56% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY L. JOHNSON | 711 S. OLIVE STREET APT. 314 LOS ANGELES, CA 90014 | AFLAC | $83 | $12 | $95 | 0.56% |
| THE HORTON GROUP3 Filed as: GARRETT MICHAEL HORTON | 4906 VIA EL SERENO TORRANCE, CA 90505 | AFLAC | $89 | — | $89 | 0.52% |
| ADAM H MICHAELS3 Filed as: ADAM H. MICHAELS | 2922 CORDA LANE LOS ANGELES, CA 90049 | AFLAC | $81 | — | $81 | 0.48% |
| EDUARDO GUEDEA SR3 Filed as: EDUARDO GUEDEA DR. | 1285 W. SHAW AVENUE SUITE 101 VENICE, CA 90291 | AFLAC | $66 | — | $66 | 0.39% |
| STEVEN EDGELL JR3 Filed as: STEVEN ROVERT EDGELL JR. | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $43 | — | $43 | 0.25% |
| BRANDON M. CROTHERS3 | 1822 ROOSEVELT AVENUE UNIT B SAN DIEGO, CA 92109 | AFLAC | $39 | — | $39 | 0.23% |
| DANIEL HOSHINA3 | 1400 APPALACHIAN PLACE CHULA VISTA, CA 91915 | AFLAC | $27 | — | $27 | 0.16% |
| JUDSON T LAW3 Filed as: JUDSON T. LAW | 7654 N. WILLOW WALK LANE EAGLE MOUNTAIN, UT 84005 | AFLAC | $26 | — | $26 | 0.15% |
| ILIC-STONE INS SERVICES INC3 Filed as: ILIC STONE INSURANCE SERVICES INC. | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $23 | — | $23 | 0.14% |
| LAURA CORRAL3 | 1211 S. CATALINA STREET APT. 1 LOS ANGELES, CA 90006 | AFLAC | $23 | — | $23 | 0.14% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVENUE LOS ANGELES, CA 90045 | AFLAC | $18 | — | $18 | 0.11% |
| MICHAEL C WALKER3 Filed as: MICHAEL A. STACHOWIAK | 321 N. CLARK STREET SUITE 625 CHICAGO, IL 60654 | AFLAC | $18 | — | $18 | 0.11% |
| JD HOLDER ENTERPRISES INC3 Filed as: JD HOLDER ENTERPRISES INC. | 8220 UNIVERSITY AVENUE SUITE 200 LA MESA, CA 91942 | AFLAC | $17 | — | $17 | 0.10% |
| ANNETTE L. BURNS3 | 28303 BRYCE DRIVE CASTAIC, CA 91384 | AFLAC | $14 | — | $14 | 0.08% |
| ALVARO E. GARCIA3 | 5669 N. FRESNO STREET APT. 103 FRESNO, CA 93710 | AFLAC | $14 | — | $14 | 0.08% |
| ALEX L. PEREZ3 | 4169 MONTEREY AVENUE BALDWIN PARK, CA 91706 | AFLAC | $11 | — | $11 | 0.06% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D. BREDESON INSURANCE SERVICES INC. | 19043 META ROAD CORNELIUS, NC 28031 | AFLAC | $10 | — | $10 | 0.06% |
| SHEDRICK DARNELL SINGLETON3 | 11620 WILSHIRE BLVD. SUITE 210 LOS ANGELES, CA 90025 | AFLAC | $8 | — | $8 | 0.05% |
| DAMON R STREETMAN3 Filed as: DAMON R. STREETMAN | 2961 W. MAPLE LOOP DRIVE SUITE 230 LEHI, UT 84043 | AFLAC | $4 | — | $4 | 0.02% |
| JOSEPH LINVILLE3 | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $3 | — | $3 | 0.02% |
| ANDREW R GRETHEL3 Filed as: ANDREW R. GRETHEL | 600 S. HIDDEN VALLEY ROAD SUITE 150 CARLSBAD, CA 92011 | AFLAC | $3 | — | $3 | 0.02% |
| BARRY BEVERLY3 Filed as: BARRY BEVERLY AND ASSOCIATES INC. | 11521 S. BLACK FOREST DRIVE SANDY, UT 84094 | AFLAC | $3 | — | $3 | 0.02% |
| DUANE A ADAMS3 Filed as: DUANE ANDREW FRY | 641 HIGUERA STREET SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $3 | — | $3 | 0.02% |
| SIERRA N KIRSHY3 Filed as: SIERRA N. KIRSHY | 348 DIAMOND OAKS ROAD ROSEVILLE, CA 95678 | AFLAC | $3 | — | $3 | 0.02% |
| COLLEEN M LAPRADE3 Filed as: COLLEEN M. LAPRADE | 6005 HIDDEN VALLEY ROAD SUITE 150 CARLSBAD, CA 92011 | AFLAC | $2 | — | $2 | 0.01% |
| MIKE LUNDQUIST3 | 4541 S. MOSSY SPRINGS LANE SALT LAKE CITY, UT 84117 | AFLAC | $2 | — | $2 | 0.01% |
| DAWN T SUCHECKI3 Filed as: DAWN T. SUCHECKI | 3850 VINE STREET SUITE 130 RIVERSIDE, CA 92507 | AFLAC | $2 | — | $2 | 0.01% |
| DAVID BRYANT3 | 12304 SANTA MONICA BLVD. SUITE 330 LOS ANGELES, CA 90025 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $221 | $2K | 16.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $155 | $1K | 17.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $830 | — | $830 | 16.30% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFITS PROGRAMS INC. | AON COMPANY 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $155 | $66 | $221 | 4.51% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | P.O. BOX 62949 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $76 | — | $76 | 1.55% |
| LOUIS R FAIOLA3 Filed as: LOUIS J. PANTALONE | CUSTOM BENEFITS PROGRAMS INC. P.O. BOX 1116 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.12% |
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 | 382 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 388 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 547 | $2.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 278 | $249K |
| Vision | VISION SERVICE PLAN | 217 | $38K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 370 | $57K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 370 | $29K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 71 | $28K |
| Other(5 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 370 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 547 | — |
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."
No prospect flags tripped on this filing.