| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $161K | $125 | $161K | 1.90% |
| IMA, INC.3 | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $15K | $242K | $257K | 4.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $69K | $12K | $81K | 9.83% |
| 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 INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $44K | $9K | $53K | 18.14% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $12K | $12K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 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 | $17K | $3K | $21K | 17.77% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5K | $5K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $5K | $749 | $5K | 11.72% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 S. GARLAND AVENUE SUITE 203 ORLANDO, FL 328013277 | SAFEGUARD HEALTH PLANS, INC. | — | $451 | $451 | 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 | $5K | $747 | $6K | 17.22% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $731 | $731 | 2.17% |
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 | 1,225 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,130 | $14.3M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 2,136 | $870K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 780 | $5.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,225 | $293K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,225 | $117K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,130 | $14.3M |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,225 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,136 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.