| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | PO BOX 3207 BOSTON, MA 02241 | KAISER FOUNDATION HEALTH PLAN, INC. | $30K | $0 | $30K | 4.53% |
| IMA, INC.3 | PO BOX 6030 PASADENA, CA 91102 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | $0 | $3K | 0.44% |
| LOCKTON COMPANIES, LLC3 | UNKNOWN BOSTON, MA 02241 | AETNA HEALTH OF CALIFORNIA, INC. | $24K | $0 | $24K | 4.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AETNA HEALTH OF CALIFORNIA, INC. | $2K | $0 | $2K | 0.39% |
| LOCKTON COMPANIES, LLC3 | UNKNOWN BOSTON, MA 02241 | AETNA LIFE INSURANCE COMPANY | $15K | $0 | $15K | 4.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.35% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES, LLC | PO BOX 6030 PASADENA, CA 91107 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.21% |
| LOCKTON COMPANIES, LLC3 | PO BOX 650823 DALLAS, TX 75265 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.20% |
| RICKY SHIH3 | 314 SOUTH 3RD AVENUE ARCADIA, CA 91006 | AFLAC | $356 | $9 | $365 | 4.20% |
| ALICIA MARGARIT ESPINOZA3 | 170 EL DORADO STREET ARCADIA, CA 91006 | AFLAC | $303 | $20 | $323 | 3.71% |
| SERGIO ALBERTO SOLIS3 Filed as: SERGIO ALBERTO SOLIS & OTHER AGENTS | 396 SOUTH CALIFORNIA AVENUE UNIT 88 WEST COVINA, CA 91793 | AFLAC | $266 | $5 | $271 | 3.12% |
| LOCKTON COMPANIES, LLC3 | 65 MEMORIAL ROAD, SUITE 100 WEST HARTFORD, CT 06107 | AFLAC | $151 | $0 | $151 | 1.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURNACE SERVICES, LLC | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | AFLAC | $151 | $0 | $151 | 1.74% |
| MICHAEL R. FISHER3 | 50 WEST LEMON AVENUE, SUITE 2 MONROVIA, CA 91016 | AFLAC | $92 | $2 | $94 | 1.08% |
| REGINALD QUEEN3 | 50 WEST LEMON AVENUE MONROVIA, CA 91016 | AFLAC | $74 | $0 | $74 | 0.85% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS, INC. | 422 WAUPONSEE STREET MORRIS, IL 60450 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $122 | $0 | $122 | 1.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES, LLC | PO BOX 6030 PASADENA, CA 91107 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $100 | $0 | $100 | 1.33% |
| LOCKTON COMPANIES, LLC3 | PO BOX 650823 DALLAS, TX 75265 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $89 | $0 | $89 | 1.18% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 127 | $1.5M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 245 | $144K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 245 | $137K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 245 | $137K |
| Short-term disability | AFLAC | 19 | $9K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 245 | $137K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 127 | $1.5M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 245 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.