| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLANS, INC | $95K | — | $95K | 3.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 911026030 | PRINCIPAL LIFE INSURANCE COMPANY | $48K | — | $48K | 5.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD, SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS | $66K | $2K | $68K | 18.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY INS. | 3475 E. FOOTHILL BLVD, STE 100 PASADENA, CA 91107 | VISION SERVICE PLAN (VSP) | $4K | — | $4K | 2.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O BOX 6030 PASADENA, CA 91102 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 3.00% |
| WILLNER-MARCH-WHITTEKER3 Filed as: WILLNER-WHITTEKER INS SERVICES, INC | 4519 NORTH LANE DEL MAR, CA 92014 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $80 | — | $80 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 245 SOUTH LOS ROBLES AVE, STE 105 PASADENA, CA 91102 | ATLANTIC SPECIALTY INSURANCE COMPANY | $3K | — | $3K | 10.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 245 SOUTH LOS ROBLES, SUITE 105 PASADENA, CA 91101 | FOUR EVER LIFE INSURANCE CO. | $749 | — | $749 | 8.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 245 SOUTH LOS ROBLES, SUITE 105 PASADENA, CA 91101 | FOUR EVER LIFE INSURANCE CO. | $156 | — | $156 | 15.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 SERVICE PROVIDER | Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.2M |
| BOLTON & COMPANY EIN 95-1047540 INSURANCE BROKER | Insurance brokerage commissions and fees; Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | — | $208K |
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 | 2,956 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 53 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,036 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS | 2,620 | $379K |
| Dental(3 contracts, 3 carriers) | ANTHEM BLUE CROSS | 2,620 | $512K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN (VSP) | 1,473 | $184K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 2,833 | $844K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 2,833 | $844K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 2,833 | $844K |
| Prescription drug | ANTHEM BLUE CROSS | 2,620 | $370K |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS | 2,620 | $370K |
| Other(5 contracts, 5 carriers) | KAISER FOUNDATION HEALTH PLANS, INC | 2,956 | $3.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,956 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.