| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $82K | $13K | $95K | 7.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $32K | — | $32K | 4.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 5.00% |
| CARIE ANN CASSAR3 | 926 SANTIAGO AVE. LONG BEACH, CA 90804 | AFLAC | $10K | $462 | $11K | 12.03% |
| KORNELIJA NUMIC3 | 25201 PASEO DE ALICIA SUITE 210 LAGUNA HILLS, CA 92653 | AFLAC | $2K | $130 | $2K | 2.39% |
| MOLOKAI MYLES HAND3 | 1409 S. LAMAR ST. APT. 716 DALLAS, TX 75215 | AFLAC | $828 | — | $828 | 0.92% |
| STEPHANIE A REYNOSO3 Filed as: STEPHANIE A. REYNOSO | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $690 | — | $690 | 0.77% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN M. KIRKLAND | 11050 CRABAPPLE RD. SUITE 107 ROSWELL, GA 30075 | AFLAC | $500 | $95 | $595 | 0.66% |
| MARK H MAZZA3 Filed as: MARK H. MAZZA | 1070 S. RIMWOOD DR. ANAHEIM, CA 92807 | AFLAC | $470 | — | $470 | 0.52% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY. LAGO VISTA, TX 78645 | AFLAC | $442 | — | $442 | 0.49% |
| AUSTIN MICHAEL DOUGHERTY3 | 1066 GRAND AVE. UNIT A OLIVEHURST, CA 95961 | AFLAC | $235 | $38 | $273 | 0.30% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $197 | — | $197 | 0.22% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN MEILING LAWS | 11050 CRABAPPLE RD. SUITE 107 ROSWELL, GA 30075 | AFLAC | $136 | — | $136 | 0.15% |
| CASSANDRA GREEN3 | 10541 CALLE LEE SUITE 125 LOS ALAMITOS, CA 90720 | AFLAC | $122 | — | $122 | 0.14% |
| KARI S. TAMKE3 | 45 54TH PL. APT. 4 LONG BEACH, CA 90803 | AFLAC | $107 | — | $107 | 0.12% |
| CASSANDRA GREEN3 | 4341 MARION AVE. CYPRESS, CA 90630 | AFLAC | $101 | — | $101 | 0.11% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBLEN AVE. BELLFLOWER, CA 90706 | AFLAC | $95 | — | $95 | 0.11% |
| LOUIS ORTA3 | 3130 YORBA LINDA BLVD. APT. J4 FULLERTON, CA 92831 | AFLAC | $82 | — | $82 | 0.09% |
| GUSTAVO ARRIAGA II3 | 5237 N. RIVERSIDE DR. SUITE 207 FORT WORTH, TX 76137 | AFLAC | $74 | $8 | $82 | 0.09% |
| LOUIS ORTA3 | 3106 YORBA LINDA BLVD. APT. B7 FULLERTON, CA 92831 | AFLAC | $78 | — | $78 | 0.09% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $62 | — | $62 | 0.07% |
| GREGOR KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $56 | — | $56 | 0.06% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 9018 BALBOA BLVD. SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $39 | — | $39 | 0.04% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DR. SUITE 1150 IRVINE, CA 92612 | AFLAC | $37 | — | $37 | 0.04% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 3120 NE 47TH ST. FORT LAUDERDALE, FL 33308 | AFLAC | $37 | — | $37 | 0.04% |
| JUSTIN M REYNOLDS3 Filed as: JUSTIN M. REYNOLDS | 8433 ENTERPRISE CIR. SUITE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $26 | — | $26 | 0.03% |
| JASON N DOIG3 Filed as: JASON N. DOIG | 219 N. IRENA AVE. APT. 4 REDONDO BEACH, CA 90277 | AFLAC | $24 | — | $24 | 0.03% |
| VIVIAN LANZAORELLANA3 | 21 IOWA IRVINE, CA 92606 | AFLAC | $22 | — | $22 | 0.02% |
| TODD V MASON3 Filed as: TODD V. MASON | 6164 LAWRENCE ST. CYPRESS, CA 92867 | AFLAC | $19 | — | $19 | 0.02% |
| OWEN JOHNSTON3 | 796 N. HART ST. ORANGE, CA 92867 | AFLAC | $18 | — | $18 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: MATTHEW DOMINIC BROWN | 7475 CALLAGHAN RD. SAN ANTONIO, TX 78229 | AFLAC | $18 | — | $18 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: MATTHEW DOMINIC BROWN | 1259 LOOP 337 SUITE 200 NEW BRAUNFELS, TX 78130 | AFLAC | $10 | $8 | $18 | 0.02% |
| JOANNA G MATHERLY3 Filed as: JOANNA G. MATHERLY | 2000 GLEN ECHO RD. SUITE 204 NASHVILLE, TN 37215 | AFLAC | $16 | — | $16 | 0.02% |
| MARY ANN KREMENLIEV3 | 2635 RYAN RD. COCORD, CA 94518 | AFLAC | $15 | — | $15 | 0.02% |
| DENNIS A. BARRETT3 | P.O. BOX 1462 RUNNING SPRINGS, CA 92382 | AFLAC | $14 | — | $14 | 0.02% |
| JEFFORY P MERTEN3 Filed as: JEFFORY P. MERTEN | 906 NW LEWISBURG AVE. CORVALLIS, OR 97330 | AFLAC | $14 | — | $14 | 0.02% |
| LIVIER MARIA RAMIREZ3 | 1107 FAIR OAKS AVE. UNIT 882 SOUTH PASADENA, CA 91030 | AFLAC | $12 | — | $12 | 0.01% |
| RACHEL L. WILSON3 | 1408 GATEWOOD CT. MARTINEZ, CA 94553 | AFLAC | $11 | — | $11 | 0.01% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR. WALNUT CREEK, CA 94598 | AFLAC | $11 | — | $11 | 0.01% |
| DALE I DAVIS3 Filed as: DALE I. DAVIS | 1856 TRAVELLER RD. LEXINGTON, KY 40504 | AFLAC | $10 | — | $10 | 0.01% |
| DALE I DAVIS3 Filed as: DALE I. DAVIS | 5892 CEDARCREEK LN. LEXINGTON, KY 40515 | AFLAC | $9 | — | $9 | 0.01% |
| DENNET MICHEL WITHINGTON3 | 5495 BARTLETT DRR. SAN BERNARDINO, CA 92407 | AFLAC | $6 | — | $6 | 0.01% |
| ANA PATRICIA ARRIAGA3 | 980 ARLINGTON CIR. WOODLAND, CA 95695 | AFLAC | $6 | — | $6 | 0.01% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR. LA VERNE, CA 91750 | AFLAC | $5 | — | $5 | 0.01% |
| SHANE M OWEN3 Filed as: SHANE CRAIG DAVISON | 120 PROVIDENCE TRL. APT. 1200 MT. JULIET, TN 37122 | AFLAC | $4 | — | $4 | 0.00% |
| MARYNA KORENEVA3 | 7725 GATEWAY UNIT 1534 IRVINE, CA 92618 | AFLAC | $4 | — | $4 | 0.00% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 300 E. ESPLANADE DR. SUITE 1220 OXNARD, CA 93036 | AFLAC | $3 | — | $3 | 0.00% |
| TERRANCE M LUCZAJ3 Filed as: TERRANCE M. LUCZAJ | 435 HARRODS LN. CHARLESTON, SC 29412 | AFLAC | $3 | — | $3 | 0.00% |
| AUSTIN MICHAEL DOUGHERTY3 | 9304 FREEDOM RD. UNIT 611 SAPULPA, OK 74066 | AFLAC | $3 | — | $3 | 0.00% |
| SETH JAFFE3 Filed as: SETH L. JAFFE | 4127 E. MASSACHUSETTS STT. LONG BEACH, CA 90814 | AFLAC | $2 | — | $2 | 0.00% |
| GUILLERMO H PALOMINO3 Filed as: GUILLERMO H. PALOMINO | 21155 N. 56TH ST. APT. 2120 PHOENIX, AZ 85054 | AFLAC | $2 | — | $2 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 728 MERCER PL. HUNTERSVILLE, NC 28078 | AFLAC | $2 | — | $2 | 0.00% |
| GUILLERMO H PALOMINO3 Filed as: GUILLERMO H. PALOMINO | 2319 E. EDNA AVE. PHOENIX, AZ 85022 | AFLAC | $2 | — | $2 | 0.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | P.O. BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
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 | 442 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 443 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 437 | $2.0M |
| Dental | BLUE CROSS OF CALIFORNIA | 437 | $1.2M |
| Vision | BLUE CROSS OF CALIFORNIA | 437 | $1.2M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 437 | $1.3M |
| Short-term disability | AFLAC | 71 | $90K |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 437 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 437 | — |
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.