| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $87K | $3K | $90K | 5.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 0.08% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $58K | $17 | $58K | 4.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 2.53% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE CALIFORNIA | 12404 PARK CENTRAL DR. SUITE 400S DALLAS, TX 752511814 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $2K | $2K | 1.36% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | $2 | $6K | 4.71% |
| CARIE ANN CASSAR3 | 5615 E. SORRENTO DRIVE LONG BEACH, CA 90803 | AFLAC | $3K | $17 | $3K | 4.89% |
| KORNELIJA NUMIC3 | 17621 17TH STREET APT. 27B TUSTIN, CA 92780 | AFLAC | $807 | — | $807 | 1.34% |
| TOMMY C FLEESON3 Filed as: TOMMY C. FLEESON | 3395 MICHELSON DR. APT. 5155 IRVINE, CA 92612 | AFLAC | $454 | $54 | $508 | 0.84% |
| STEPHANIE A REYNOSO3 Filed as: STEPHANIE A. REYNOSO | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $332 | $17 | $349 | 0.58% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY. LAGO VISTA, TX 78645 | AFLAC | $306 | — | $306 | 0.51% |
| DENISE M. AVILA WALKER3 | 2605 ADELITA DR. HACIENDA HEIGHTS, CA 91745 | AFLAC | $235 | $57 | $292 | 0.49% |
| MOLOKAI MYLES HAND3 | 3309 WOLFE CT. PLANO, TX 75025 | AFLAC | $282 | — | $282 | 0.47% |
| MARK H MAZZA3 Filed as: MARK H. MAZZA | 1070 S. RIMWOOD DRIVE ANAHEIM, CA 92807 | AFLAC | $184 | — | $184 | 0.31% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 5460 E. EL PARQUE STREET LONG BEACH, CA 90815 | AFLAC | $181 | — | $181 | 0.30% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN M. KIRKLAND | 1270 HOPEWELL CREST ALPHARETTA, GA 30004 | AFLAC | $126 | — | $126 | 0.21% |
| JAN MARIE3 | P.O. BOX 3231 COEUR D ALENE, ID 83816 | AFLAC | $119 | — | $119 | 0.20% |
| CASSANDRA GREEN3 | 4276 KATELLA AVE. PMB 185 LOS ALAMITOS, CA 90720 | AFLAC | $91 | — | $91 | 0.15% |
| KARI S. TAMKE3 | 45 54TH PL. APT. 4 LONG BEACH, CA 90803 | AFLAC | $90 | — | $90 | 0.15% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $52 | — | $52 | 0.09% |
| GREGOR KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $52 | — | $52 | 0.09% |
| GUSTAVO ARRIAGA II3 | 320 W. CORK TREE DR. ORANGE, CA 92865 | AFLAC | $50 | — | $50 | 0.08% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 14747 N. NORTHSIGHT BLVD. SUITE 111-454 SCOTTSDALE, AZ 85260 | AFLAC | $33 | — | $33 | 0.05% |
| MARCI MARIE OTIS3 | 200 JULINA LN. ROSEBURG, OR 97471 | AFLAC | $32 | — | $32 | 0.05% |
| JASON N DOIG3 Filed as: JASON N. DOIG | 1260 W. ADAMS BLVD. LOS ANGELES, CA 90007 | AFLAC | $30 | — | $30 | 0.05% |
| LOUIS ORTA3 | 3985 S. SUNRISE AVE. ONTARIO, CA 91761 | AFLAC | $30 | — | $30 | 0.05% |
| ALASKA BENEFIT SERVICES LLC3 | 3401 PEGER RD. SUITE A FAIRBANKS, AK 99709 | AFLAC | $26 | — | $26 | 0.04% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBLEN AVE. BELLFLOWER, CA 90706 | AFLAC | $25 | — | $25 | 0.04% |
| JUSTIN M REYNOLDS3 Filed as: JUSTIN M. REYNOLDS | 8433 ENTERPRISE CIR. SUITE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $24 | — | $24 | 0.04% |
| JOHN PAUL WARNKE3 | 3401 PEGER RD. SUITE A FAIRBANKS, AK 99709 | AFLAC | $23 | — | $23 | 0.04% |
| ACRISURE LLC3 | 582 E. 36TH AVE. SUITE 500 ANCHORAGE, AK 99503 | AFLAC | $23 | — | $23 | 0.04% |
| CAROL A. KENYON3 | 1645 CLEVELAND HILL RD. ROSEBURG, OR 97471 | AFLAC | $21 | — | $21 | 0.03% |
| AUSTIN MICHAEL DOUGHERTY3 | 9304 FREEDOM RD. UNIT 611 SAPULPA, OK 74066 | AFLAC | $21 | — | $21 | 0.03% |
| JODY L WALK3 Filed as: JODY L. WALK | 35689 ROSE MOSS AVE. LEESBURG, FL 34788 | AFLAC | $20 | — | $20 | 0.03% |
| TERRY K ALLEN3 Filed as: TERRY K. ALLEN | 20930 E. HAPPY TRAILS LN. OTIS ORCHARDS, WA 99027 | AFLAC | $19 | — | $19 | 0.03% |
| LISA M HALL3 Filed as: LISA M. HALL | 686 W. MOGUL LOOP APT. 102 HAYDEN, ID 83835 | AFLAC | $18 | — | $18 | 0.03% |
| TODD V MASON3 Filed as: TODD V. MASON | 1607 W. PACIFIC COAST HWY APT. 144 WILMINGTON, CA 90744 | AFLAC | $17 | — | $17 | 0.03% |
| JOANNA G MATHERLY3 Filed as: JOANNA G. MATHERLY | 4581 MAJESTIC MEADOWS DR. ARRINGTON, TN 37014 | AFLAC | $14 | — | $14 | 0.02% |
| KAREN PICCININI3 Filed as: KAREN BALL | 11683 N. EMERALD DRIVE HAYDEN, ID 83835 | AFLAC | $14 | — | $14 | 0.02% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 3928 IRONBARK WAY MCKINNEY, TX 75071 | AFLAC | $12 | — | $12 | 0.02% |
| SHAUNNA FERRENBURG3 | 1809 W. 104TH AVE. ANCHORAGE, AK 99515 | AFLAC | $11 | — | $11 | 0.02% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 438 PISGAH PIKE PULASKI, TN 38478 | AFLAC | $11 | — | $11 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: MATTHEW DOMINIC BROWN | 490 43RD ST. SUITE 1009 OAKLAND, CA 94609 | AFLAC | $10 | — | $10 | 0.02% |
| ARTHUR F. BELL3 | 1518 TURPIN ST. ANCHORAGE, AK 99504 | AFLAC | $10 | — | $10 | 0.02% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR. WALNUT CREEK, CA 94598 | AFLAC | $10 | — | $10 | 0.02% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LN. LEXINGTON, KY 40515 | AFLAC | $10 | — | $10 | 0.02% |
| OWEN JOHNSTON3 | 1300 FAIRHAVEN AVE. APT. 3 SANTA ANA, CA 92705 | AFLAC | $10 | — | $10 | 0.02% |
| CLACK ATTACK AGENCY, LLC3 Filed as: CLACK ATTACH AGENCY, LLC | 4215 BOULDER CT. GIG HARBOR, WA 98332 | AFLAC | $10 | — | $10 | 0.02% |
| GUY R SOUTER3 Filed as: GUY R. SOUTER | 1930 VILLAGE CENTER CIR. SUITE 3 PMB 5962 LAS VEGAS, NV 89134 | AFLAC | $9 | — | $9 | 0.01% |
| DARAN L WYCKOFF3 Filed as: DARAN L. WYCKOFF | P.O. BOX 31233 SPOKANE, WA 99223 | AFLAC | $8 | — | $8 | 0.01% |
| JEFF DALABA3 Filed as: JEFF CLACK | 4215 BOULDER CT. GIG HARBOR, WA 98332 | AFLAC | $7 | — | $7 | 0.01% |
| MARY ANN KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $6 | — | $6 | 0.01% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR. LA VERNE, CA 91750 | AFLAC | $5 | — | $5 | 0.01% |
| JEFFORY P MERTEN3 Filed as: JEFFORY P. MERTEN | 906 NW LEWISBURG AVE. CORVALLIS, OR 97330 | AFLAC | $5 | — | $5 | 0.01% |
| ANA PATRICIA ARRIAGA3 | 980 ARLINGTON CIR. WOODLAND, CA 95695 | AFLAC | $4 | — | $4 | 0.01% |
| JEROMY E. CILLEY3 | 2683 E. WILSHIRE DR. EUGENE, OR 97405 | AFLAC | $4 | — | $4 | 0.01% |
| GUILLERMO H PALOMINO3 Filed as: GUILLERMO H. PALOMINO | 14224 N. 26TH DRIVE PHOENIX, AZ 85023 | AFLAC | $3 | — | $3 | 0.00% |
| TAYLOR INSURANCE, INC.3 Filed as: TAYLOR INSURANCE INC. | P.O. BOX 171 SANDPOINT, ID 83864 | AFLAC | $3 | — | $3 | 0.00% |
| LIVIER MARIA RAMIREZ3 | 1107 FAIR OAKS AVE. PMB 882 SOUTH PASADENA, CA 91030 | AFLAC | $3 | — | $3 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE NORTHWEST PART INS. SVCS. | 582 E. 36TH AVE. SUITE 500 ANCHORAGE, AK 99503 | AFLAC | $2 | — | $2 | 0.00% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 1139 IROLO ST. LOS ANGELES, CA 90006 | AFLAC | $2 | — | $2 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 149 MALIBU RD. MOORESVILLE, NC 28117 | AFLAC | $1 | — | $1 | 0.00% |
| IOANNIS T GRATSINOPOULOS3 Filed as: IOANNIS T. GRATSINOPOULOS | 1893 E. DAULBY ST. MERIDIAN, ID 83642 | AFLAC | $1 | — | $1 | 0.00% |
| RAYMON P KEECH III3 Filed as: RAYMON P. KEECH III | 8207 CAMPAIGN CIRCLE RICHMOND, TX 77406 | AFLAC | $1 | — | $1 | 0.00% |
| SHANE EDMUND ATTEBERY3 | 391 RANDY DR. GRANTS PASS, OR 97527 | AFLAC | $1 | — | $1 | 0.00% |
| SETH JAFFE3 Filed as: SETH L. JAFFE | 4127 E. MASSACHUSETTS ST. LONG BEACH, CA 90814 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | STANDARD INSURANCE COMPANY | $5K | $615 | $6K | 11.07% |
| IMA, INC.3 | 1705 17TH STREET SUITE 100 DENVER, CO 80202 | STANDARD INSURANCE COMPANY | — | $37 | $37 | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 430 E. DOUGLAS AVE. SUITE 400 WICHITA, KS 672023409 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 14.98% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | PRINCIPAL LIFE INSURANCE COMPANY | -$282 | — | -$282 | -1.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM LIFE INSURANCE COMPANY | $1K | — | $1K | 6.73% |
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 | 483 | 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) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 542 | $3.2M |
| Dental | BLUE CROSS OF CALIFORNIA | 542 | $1.8M |
| Vision | BLUE CROSS OF CALIFORNIA | 542 | $1.8M |
| Life insurance(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 481 | $92K |
| Short-term disability | AFLAC | 46 | $60K |
| Prescription drug(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 542 | $3.2M |
| Other(4 contracts, 4 carriers) | AFLAC | 481 | $152K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 542 | — |
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.