| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $56K | — | $56K | 5.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | $649 | $9K | 10.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | SUN LIFE ASSURANCE COMPANY OF CANADA | $10K | — | $10K | 12.66% |
| MGIS3 | 111 S. MAIN STREET SUITE 400 SALT LAKE CITY, UT 84111 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $150 | $150 | 0.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CALIFORNIACHOICE | $2K | — | $2K | 4.96% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $526 | $19 | $545 | 2.29% |
| USI INSURANCE SERVICES LLC3 | 27100 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $533 | $4 | $537 | 2.26% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $358 | $5 | $363 | 1.53% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $191 | $10 | $201 | 0.84% |
| JOHN A. BRADLEY INC.3 | 207 S. MAIN STREET FOUNTAIN INN, SC 29644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $102 | — | $102 | 0.43% |
| VGM BENEFIT ENROLLMENTS LLC3 | 30310 HORSETHIEF DRIVE TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $71 | $15 | $86 | 0.36% |
| DEL DOWNEY3 | 32056 MERLOT CREST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | — | $43 | 0.18% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC - WEST | IRVINE OPCO P.O. BOX 62683 VIRGINIA BEACH, VA 234662683 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $905 | $917 | $2K | 8.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.97% |
| MJ INSURANCE3 Filed as: CLAUDIA E. DONOFRIO | 10541 CALLE LEE STREET SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $986 | — | $986 | 4.96% |
| JASON DAVIS INSURANCE SERVICES INC3 Filed as: JASON DAVIS INSURANCE SERVICES INC. | 10571 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $798 | — | $798 | 4.01% |
| JARETT JAMES PAHOA3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $740 | — | $740 | 3.72% |
| SANDRA R ROKOP3 Filed as: SANDRA P. ROKOP | 36471 ROYAL SAGE COURT PALM DESERT, CA 92211 | AFLAC | $736 | — | $736 | 3.70% |
| DONALD F WASINGER3 Filed as: DONALD F. WASINGER | 36471 ROYAL SAGE COURT PALM DESERT, CA 92211 | AFLAC | $439 | — | $439 | 2.21% |
| CASSANDRA GREEN3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $369 | — | $369 | 1.86% |
| JASON DAVIS INSURANCE SERVICES INC3 Filed as: JASON DAVIS INSURANCE SERVICES INC. | 12361 LEWIS STREET SUITE 201 GARDEN GROVE, CA 92840 | AFLAC | $256 | — | $256 | 1.29% |
| NICHOLAS K. GREEN3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $173 | — | $173 | 0.87% |
| JANICE M ADAMSON3 Filed as: JANICE M. ADAMSON | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $128 | — | $128 | 0.64% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 21250 HAWTHORNE BLVD. SUITE 600 TORRANCE, CA 90503 | AFLAC | $74 | — | $74 | 0.37% |
| DANIEL TYLER ADAMSON3 | 405 S. HIBISCUS WAY ANAHEIM, CA 92808 | AFLAC | $58 | — | $58 | 0.29% |
| G SCOTT COOKE3 Filed as: SCOTT BLACKSHEAR | 3453 CATHRYN DRIVE COLUMBUS, GA 31906 | AFLAC | $24 | — | $24 | 0.12% |
| JAMES P BOADA3 Filed as: JAMES P. BOADA | 30991 VIA MIRADOR SAN JUAN CAPISTRANO, CA 92675 | AFLAC | $22 | — | $22 | 0.11% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 435 HARRODS LANE CHARLESTON, SC 29412 | AFLAC | $14 | — | $14 | 0.07% |
| ANDREW R GRETHEL3 Filed as: ANDREW R. GRETHEL | 11739 HICKORY RUN COURT LOVELAND, OH 45140 | AFLAC | $10 | — | $10 | 0.05% |
| PEGGY K SALMON3 Filed as: PEGGY K. SALMON | 2203 AVENIDA OLIVIA SAN CLEMENTE, CA 92673 | AFLAC | $9 | — | $9 | 0.05% |
| TOMMY C FLEESON3 Filed as: TOMMY C. FLEESON | 1300 SHETTER AVENUE APT. 1041 JACKSONVILLE BEACH, FL 32250 | AFLAC | $7 | — | $7 | 0.04% |
| JAMES J GRETHEL3 Filed as: JAMES J. GRETHEL | 865 CEDAR DRIVE LOVELAND, OH 45140 | AFLAC | $4 | — | $4 | 0.02% |
| AMANDA M GRIFFITH3 Filed as: AMANDA M. GRIFFITH | 11400 SE 8TH STREET SUITE 375 BELLEVUE, WA 98004 | AFLAC | $4 | — | $4 | 0.02% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $3 | — | $3 | 0.02% |
| JEFFREY T JOHNSON3 Filed as: JEFFREY T. JOHNSON | 30766 MAINMAST DRIVE AGOURA HILLS, CA 91301 | AFLAC | $3 | — | $3 | 0.02% |
| CHRIS BRANSON3 | 6601 BACK BAY LANE AUSTIN, TX 78739 | AFLAC | $2 | — | $2 | 0.01% |
| ALBERT MARZULLO3 Filed as: ALBERT GEORGE MARZULLO | 161 PINE COVE KYLE, TX 78640 | AFLAC | $1 | — | $1 | 0.01% |
| KERSTIN J VANZANTEN3 Filed as: KERSTIN J. VANZANTEN | 40152 STOWE ROAD TEMECULA, CA 92591 | AFLAC | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $194 | $24 | $218 | 5.72% |
| USI INSURANCE SERVICES LLC3 | P.O. BOX 62949 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $186 | $14 | $200 | 5.25% |
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 | 160 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 252 | $1.1M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 199 | $83K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 199 | $83K |
| Life insurance(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 160 | $102K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 25 | $24K |
| Long-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 173 | $100K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 252 | $1.1M |
| Other(4 contracts, 4 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 160 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 252 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.