| 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. | $180K | $6K | $186K | 4.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $11K | $109K | $120K | 4.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $65K | $6K | $71K | 10.86% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 328013277 | METROPOLITAN LIFE INSURANCE COMPANY | — | $6K | $6K | 0.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $33K | $2K | $35K | 15.79% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $9K | $9K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 0.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $632 | $12K | 15.82% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $6K | $6K | 8.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $717 | $717 | 0.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $5K | $428 | $5K | 10.84% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 328013277 | SAFEGUARD HEALTH PLANS, INC. | — | $419 | $419 | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $223 | $4K | 16.01% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$18 | $904 | $886 | 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 | 943 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 945 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 869 | $7.0M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,510 | $699K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 412 | $2.7M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 943 | $219K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 943 | $77K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 869 | $7.0M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 943 | $241K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,510 | — |
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.