| 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. | $125K | $7K | $132K | 4.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | BLUE CROSS OF CALIFORNIA | $61K | — | $61K | 5.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $43K | — | $43K | 9.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $21K | — | $21K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $6K | $6K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $655 | $655 | 4.00% |
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 | 788 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 792 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 680 | $4.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 635 | $437K |
| Vision | BLUE CROSS OF CALIFORNIA | 144 | $1.2M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 789 | $138K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 789 | $49K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 680 | $4.4M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 789 | $154K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 789 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.