| 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. | $77K | $1K | $78K | 3.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $26K | $686 | $26K | 10.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $717 | $6K | 13.67% |
| 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 | $3K | $414 | $3K | 15.05% |
| JACOB BURNS INC.3 | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $418 | — | $418 | 6.02% |
| KATRINA LAFATA3 | 11637 GORHAM AVENUE APT. 106 LOS ANGELES, CA 90049 | AFLAC | $62 | — | $62 | 0.89% |
| CORI CAMPBELL3 | 4518 186TH STREET APT. 203 REDONDO BEACH, CA 90278 | AFLAC | $53 | — | $53 | 0.76% |
| OLENA K SHEA3 Filed as: OLENA SHEA | 3 MITCHELL PLACE UNIT 18C NEW YORK, NY 10017 | AFLAC | $49 | — | $49 | 0.71% |
| JAIME PUERTA3 | 28443 SANTA CATARINA ROAD SANTA CLARITA, CA 91350 | AFLAC | $48 | — | $48 | 0.69% |
| LANE P MORGAN3 Filed as: LANE MORGAN | 672 CYNTHIA LANE SANTA CLARA, UT 84765 | AFLAC | $38 | — | $38 | 0.55% |
| ADAM H MICHAELS3 Filed as: ADAM MICHAELS | 2922 CORDA LANE LOS ANGELES, CA 90049 | AFLAC | $36 | — | $36 | 0.52% |
| EDUARDO GUEDEA SR3 | 816 BROOKS AVENUE VENICE, CA 90291 | AFLAC | $32 | — | $32 | 0.46% |
| BRYSTRA INSURANCE SERVICES3 Filed as: BRYSTRA INSURANCE SERVICES, INC. | 11150 W. OLYMPIC BLVD. SUITE 780 LOS AGELES, CA 90064 | AFLAC | $25 | — | $25 | 0.36% |
| STEVEN EDGELL JR3 | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $21 | — | $21 | 0.30% |
| BRANDON M. CROTHERS3 Filed as: BRANDON CROTHERS | 1822 ROOSEVELT AVENUE UNIT B SAN DIEGO, CA 92109 | AFLAC | $15 | — | $15 | 0.22% |
| THE HORTON GROUP3 Filed as: GARRETT HORTON | 4906 VIA EL SERENO TORRANCE, CA 90505 | AFLAC | $14 | — | $14 | 0.20% |
| TOMMY L JOHNSON JR3 Filed as: TOMMY JOHNSON JR | 711 S. OLIVE STREET APT. 314 LOS ANGELES, CA 90014 | AFLAC | $11 | — | $11 | 0.16% |
| ILIC-STONE INS SERVICES INC3 Filed as: ILIC-STONE INSURANCE SERVICES INC. | 1285 W. SHAW AVENUE SUITE 101 FRESNO, CA 93711 | AFLAC | $11 | — | $11 | 0.16% |
| JUDSON T LAW3 Filed as: JUDSON LAW | 7654 N. WILLOW WALK LANE EAGLE MOUNTAIN, UT 84005 | AFLAC | $10 | — | $10 | 0.14% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVENUE LOS ANGELES, CA 90045 | AFLAC | $8 | — | $8 | 0.12% |
| MICHAEL C WALKER3 Filed as: MICHAEL STACHOWIAK | 321 N. CLARK STREET SUITE 625 CHICAGO, IL 60654 | AFLAC | $8 | — | $8 | 0.12% |
| HORACIO J. LANZAS3 Filed as: HORACIO LANZAS | 7032 BAIRD AVENUE RESEDA, CA 91335 | AFLAC | $7 | — | $7 | 0.10% |
| JD HOLDER ENTERPRISES INC3 Filed as: JD HOLDER ENTERPRISES INC. | 8220 UNIVERSITY DRIVE SUITE 200 LA MESA, CA 91942 | AFLAC | $7 | — | $7 | 0.10% |
| ALEX L. PEREZ3 Filed as: ALEX PEREZ | 4169 MONTEREY AVENUE BALDWIN PARK, CA 91706 | AFLAC | $6 | — | $6 | 0.09% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D BREDESON INSURANCE SERVICES INC. | 19043 META ROAD CORNELIUS, NC 28031 | AFLAC | $5 | — | $5 | 0.07% |
| ANNETTE BURNS3 | 28303 BRYCE DRIVE CASTAIC, CA 91384 | AFLAC | $4 | — | $4 | 0.06% |
| DAMON STREETMAN3 | 2961 W. MAPLE LOOP DRIVE SUITE 230 LEHI, UT 84043 | AFLAC | $1 | — | $1 | 0.01% |
| DUANE FRY3 | 641 HIGUERA STREET SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $1 | — | $1 | 0.01% |
| SIERRA N KIRSHY3 Filed as: SIERRA KIRSHY | 348 DIAMOND OAKS ROAD ROSEVILLE, CA 95678 | AFLAC | $1 | — | $1 | 0.01% |
| ANDREW R GRETHEL3 Filed as: ANDREW GRETHEL | 11739 HICKORY RUN COURT LOVELAND, OH 45140 | AFLAC | $1 | — | $1 | 0.01% |
| BARRY BEVERLY3 | 1888 E. 6400 SOUTH HOLLADAY, UT 84121 | AFLAC | $1 | — | $1 | 0.01% |
| DAWN T SUCHECKI3 Filed as: DAWN SUCHECKI | 225 S. WATER STREET WILMINGTON, NC 28401 | AFLAC | $1 | — | $1 | 0.01% |
| COLLEEN LAPRADE3 | 6005 HIDDEN VALLEY ROAD SUITE 150 CARLSBAD, CA 92011 | AFLAC | $1 | — | $1 | 0.01% |
| MIKE LUNDQUIST3 Filed as: MIKE LINDQUIST | 4541 S. MOSSY SPRINGS LANE SALT LAKE CITY, UT 84117 | 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 | $737 | $116 | $853 | 15.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $588 | $179 | $767 | 17.54% |
| USI INSURANCE SERVICES LLC3 | 1 INTERNATIONAL PLAZA 4TH FLOOR PHILADELPHIA, PA 19113 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $418 | $28 | $446 | 10.46% |
| CUSTOM BENEFITS PROGRAMS3 Filed as: CUSTOM BENEFITS PROGRAMS INC. | AON COMPANY 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $105 | $48 | $153 | 3.59% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | P.O. BOX 62949 VIRGINIA BEACH, VA 23466 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $51 | — | $51 | 1.20% |
| 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 | $3 | — | $3 | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $355 | — | $355 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $226 | — | $226 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $209 | — | $209 | 10.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $412 | — | $412 | 22.48% |
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 | 398 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 403 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 551 | $2.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 266 | $258K |
| Vision | VISION SERVICE PLAN | 215 | $40K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 398 | $49K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 64 | $11K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 72 | $21K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 551 | $2.6M |
| Other(8 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 398 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 551 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.