| 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. | $62K | $2K | $65K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SUN LIFE ASSURANCE COMPANY OF CANADA | $19K | — | $19K | 14.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | — | $12K | 11.88% |
| MGIS3 | 111 S. MAIN STREET SUITE 400 SALT LAKE CITY, UT 84111 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $180 | $180 | 0.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CALIFORNIACHOICE | $4K | — | $4K | 4.97% |
| USI INSURANCE SERVICES LLC3 | 27100 OXNARD STREET SUITE 1200 WOODLAND HILLS, CA 91367 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | — | $82 | 2.14% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $82 | — | $82 | 2.14% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $49 | — | $49 | 1.28% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.78% |
| JOHN A. BRADLEY INC.3 | 207 S. MAIN STREET FOUNTAIN INN, SC 29644 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.47% |
| VGM BENEFIT ENROLLMENTS LLC3 | 30310 HORSETHIEF DRIVE TEHACHAPI, CA 93561 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.18% |
| DEL DOWNEY3 | 32056 MERLOT CREST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.16% |
| JASON DAVIS INSURANCE SERVICES INC3 Filed as: JASON DAVIS INSURANCE SERVICES INC. | 8260 E. ELLENFORD STREET LONG BEACH, CA 90808 | AFLAC | $35 | — | $35 | 17.50% |
| MJ INSURANCE3 Filed as: CLAUDIA E. DONOFRIO | 3591 PROMROSE CIRCLE SEAL BACH, CA 90740 | AFLAC | $31 | — | $31 | 15.50% |
| JARETT JAMES PAHOA3 | 4489 LARWIN AVENUE CYPRESS, CA 90630 | AFLAC | $24 | — | $24 | 12.00% |
| CASSANDRA GREEN3 | 4341 MARION AVENUE CYPRESS, CA 90630 | AFLAC | $12 | — | $12 | 6.00% |
| NICHOLAS K. GREEN3 | 4195 N. VIKING WAY SUITE 120 LONG BEACH, CA 90808 | AFLAC | $6 | — | $6 | 3.00% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 21250 HAWTHORNE BLVD. SUITE 380 TORRANCE, CA 90503 | AFLAC | $2 | — | $2 | 1.00% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 243 | $1.4M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $132K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $132K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 200 | $98K |
| Short-term disability(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $136K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 200 | $97K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 243 | $1.4M |
| Other(4 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 211 | $234K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 243 | — |
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.