| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | PO BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN INC. | $32K | $0 | $32K | 4.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AETNA HEALTH OF CALIFORNIA INC. | $26K | $0 | $26K | 4.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AETNA LIFE INSURANCE COMPANY | $13K | $2K | $15K | 5.61% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $35K | $8K | $44K | 22.38% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $109 | $109 | 0.06% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $0 | $147 | $147 | 1.11% |
| RICKY SHIH3 | 314 SOUTH 3RD AVENUE ARCADIA, CA 91006 | AFLAC | $769 | $10 | $779 | 5.96% |
| ALICIA MARGARIT ESPINOZA3 | 170 EL DORADO STREET ARCADIA, CA 91006 | AFLAC | $424 | $0 | $424 | 3.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AFLAC | $307 | $0 | $307 | 2.35% |
| MICHAEL R. FISHER3 | 50 WEST LEMON AVENUE, SUITE 2 MONROVIA, CA 91016 | AFLAC | $239 | $2 | $241 | 1.84% |
| JOSEPH HOFFMAN3 | 29110 TEMBUSO LAKE ELSINORE, CA 92530 | AFLAC | $224 | $0 | $224 | 1.71% |
| JULIA MELLO3 | 5501 ONACREST DRIVE LOS ANGELES, CA 90043 | AFLAC | $168 | $0 | $168 | 1.29% |
| SHANE DAVISON3 Filed as: SHANE CRAIG DAVISON & OTHER AGENTS | 3013 LARGE HOP LANE ANTIOCH, TN 37013 | AFLAC | $120 | $0 | $120 | 0.92% |
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 | 95 | 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) | 97 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 126 | $1.4M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 224 | $208K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 224 | $195K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 224 | $195K |
| Short-term disability | AFLAC | 17 | $13K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 224 | $195K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 126 | $1.4M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 224 | $208K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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.