| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $213K | — | $213K | 3.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $12K | $144K | $156K | 4.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $73K | $109 | $73K | 9.89% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 328013277 | METROPOLITAN LIFE INSURANCE COMPANY | — | $8K | $8K | 1.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $42K | $4K | $47K | 16.56% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$178 | $11K | $11K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$44 | $3K | $3K | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $2K | $15K | 16.71% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $4K | $4K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $876 | $876 | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $5K | — | $5K | 9.85% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 328013277 | SAFEGUARD HEALTH PLANS, INC. | — | $519 | $519 | 0.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $453 | $6K | 16.33% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 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 | 1,053 | 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) | 1,053 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,673 | $10.0M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,818 | $791K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 523 | $3.6M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $282K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $88K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 1,064 | $10.0M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,053 | $316K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,818 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.