| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $18K | $314K | $332K | 4.30% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $155K | $878 | $156K | 2.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $51K | — | $51K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $14K | $14K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $23K | — | $23K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $6K | $6K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.00% |
| IMA, INC.3 | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $8K | $8K | 5.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 15.00% |
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 | 1,228 | 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) | 1,228 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 1,091 | $15.2M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $141K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 866 | $7.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,227 | $340K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,227 | $152K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 1,091 | $15.2M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,227 | $378K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,227 | — |
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.