| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UNITEDHEALTHCARE INSURANCE COMPANY | $46K | — | $46K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $20K | $1K | $21K | 4.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $5K | $19K | 16.46% |
| CARIE ANN CASSAR3 | 926 SANTIAGO AVE. LONG BEACH, CA 90804 | AFLAC | $7K | $466 | $8K | 12.77% |
| MARK H MAZZA3 Filed as: MARK H. MAZZA | 1070 S. RIMWOOD DR. ANAHEIM, CA 92807 | AFLAC | $861 | $93 | $954 | 1.57% |
| MOLOKAI MYLES HAND3 | 1409 S. LAMAR ST. APT. 716 DALLAS, TX 75215 | AFLAC | $673 | — | $673 | 1.11% |
| CASSANDRA GREEN3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $533 | $93 | $626 | 1.03% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY. LAGO VISTA, TX 78645 | AFLAC | $559 | — | $559 | 0.92% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN MEILING LAWS | 1932 E. DEERE AVE. SUITE 240 SANTA ANA, CA 92705 | AFLAC | $344 | — | $344 | 0.57% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $270 | — | $270 | 0.45% |
| MARYNA KORENEVA3 | 7725 GATEWAY UNIT 1534 IRVINE, CA 92618 | AFLAC | $209 | — | $209 | 0.34% |
| VIVIAN LANZAORELLANA3 | 21 IOWA IRVINE, CA 92606 | AFLAC | $188 | — | $188 | 0.31% |
| LOUIS ORTA3 | 3142 YORBA LINDA BLVD. APT. F25 FULLERTON, CA 92831 | AFLAC | $139 | — | $139 | 0.23% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBLEN AVE. BELLFLOWER, CA 90706 | AFLAC | $137 | — | $137 | 0.23% |
| GUSTAVO ARRIAGA II3 | 1140 MANGROVE AVE. SUITE D CHICO, CA 95926 | AFLAC | $91 | $16 | $107 | 0.18% |
| KARI S. TAMKE3 | 45 54TH PL. APT. 4 LONG BEACH, CA 90803 | AFLAC | $99 | — | $99 | 0.16% |
| LOUIS ORTA3 | 3106 YORBA LINDA BLVD. APT. B7 FULLERTON, CA 92831 | AFLAC | $66 | — | $66 | 0.11% |
| JASON N DOIG3 Filed as: JASON N. DOIG | 1932 E. DEERE AVE. SUITE 240 SANTA ANA, CA 92705 | AFLAC | $65 | — | $65 | 0.11% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $57 | — | $57 | 0.09% |
| GREGOR KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $52 | — | $52 | 0.09% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 3120 NE 47TH ST. FORT LAUDERDALE, FL 33308 | AFLAC | $51 | — | $51 | 0.08% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DR. SUITE 1150 IRVINE, CA 92612 | AFLAC | $39 | — | $39 | 0.06% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $37 | — | $37 | 0.06% |
| DENNIS A. BARRETT3 | P.O. BOX 1462 RUNNING SPRINGS, CA 92382 | AFLAC | $28 | — | $28 | 0.05% |
| GUSTAVO ARRIAGA II3 | 1115 GRAY AVE. YUBA CITY, CA 95991 | AFLAC | $26 | — | $26 | 0.04% |
| TODD V MASON3 Filed as: TODD V. MASON | 6164 LAWRENCE ST. CYPRESS, CA 90630 | AFLAC | $24 | — | $24 | 0.04% |
| JUSTIN M REYNOLDS3 Filed as: JUSTIN M. REYNOLDS | 8433 ENTERPRISE CIR. SUITE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $24 | — | $24 | 0.04% |
| OWEN JOHNSTON3 | 796 N. HART ST. ORANGE, CA 92867 | AFLAC | $20 | — | $20 | 0.03% |
| JOANNA G MATHERLY3 Filed as: JOANNA G. MATHERLY | 2000 GLEN ECHO RD. SUITE 204 NASHVILLE, TN 37215 | AFLAC | $18 | — | $18 | 0.03% |
| ANA PATRICIA ARRIAGA3 | 1115 GRAY AVE. YUBA CITY, CA 95991 | AFLAC | $14 | $3 | $17 | 0.03% |
| LIVIER MARIA RAMIREZ3 | 1107 FAIR OAK AVE. UNIT 882 SOUTH PASADENA, CA 91030 | AFLAC | $15 | — | $15 | 0.02% |
| DALE I DAVIS3 | 1856 TRAVELLER RD. LEXINGTON, KY 40504 | AFLAC | $14 | — | $14 | 0.02% |
| MARY ANN KREMENLIEV3 | 2635 RYAN ROAD CONCORD, CA 94518 | AFLAC | $14 | — | $14 | 0.02% |
| JEFFORY P MERTEN3 Filed as: JEFFORY P. MERTEN | 906 NW LEWISBURG AVE. CORVALLIS, OR 97330 | AFLAC | $12 | — | $12 | 0.02% |
| DENNET MICHEL WITHINGTON3 | 5495 BARTLETT DR. SAN BERNARDINO, CA 92407 | AFLAC | $12 | — | $12 | 0.02% |
| RACHEL L. WILSON3 | 1408 GATEWOOD CT. MARTINEZ, CA 94553 | AFLAC | $10 | — | $10 | 0.02% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR. WALNUT CREEK, CA 94598 | AFLAC | $10 | — | $10 | 0.02% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 120 PROVIDENCE TRL. APT. 1200 MT. JULIET, TN 37122 | AFLAC | $9 | — | $9 | 0.01% |
| DALE I DAVIS3 Filed as: DALE I. DAVIS | 350 E. SHORT ST. NUMBER 416 LEXINGTON, KY 40507 | AFLAC | $6 | — | $6 | 0.01% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 1201 MAIN ST. SUITE 2300 COLUMBIA, SC 29201 | AFLAC | $6 | — | $6 | 0.01% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR. LA VERNE, CA 91750 | AFLAC | $5 | — | $5 | 0.01% |
| GUILLERMO H PALOMINO3 Filed as: GUILLERMO H. PALOMINO | 21155 N. 56TH ST. APT. 2120 PHOENIX, AZ 85054 | AFLAC | $3 | — | $3 | 0.00% |
| SETH JAFFE3 | 4127 E. MASSACHUSETTS ST. LONG BEACH, CA 90814 | AFLAC | $3 | — | $3 | 0.00% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 110 SE 8TH ST. SUITE 1700 FT. LAUDERDALE, FL 33301 | AFLAC | $3 | — | $3 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 6631 FOX RIDGE CIRCLE DAVIDSON, NC 28036 | AFLAC | $2 | — | $2 | 0.00% |
| MARK J WOOD3 Filed as: MARK J. WOOD | 315 W. HACIENDA DR. CORONA, CA 92882 | AFLAC | $1 | — | $1 | 0.00% |
| KARLA M. TOMAS3 | 516 S. VIA MONTANA BURBANK, CA 91501 | AFLAC | $1 | — | $1 | 0.00% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 733 BISHOP ST. SUITE 2530 HONOLULU, HI 96813 | AFLAC | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | $84 | $2K | 4.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $3K | $876 | $3K | 15.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 3130 WILSHIRE BLVD. SUITE 200 SANTA MONICA, CA 90403 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.33% |
| WHITE & COMPANY INSURANCE INC.3 | 3130 WILSHIRE BLVD. SUITE 200 SANTA MONICA, CA 90403 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.67% |
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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 205 | $1.4M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 486 | $140K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 486 | $117K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 486 | $140K |
| Short-term disability | AFLAC | 56 | $61K |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 486 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 486 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.