| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $84K | $13K | $97K | 7.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $35K | $1K | $36K | 5.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | $255 | $7K | 5.20% |
| CARIE ANN CASSAR3 | 926 SANTIAGO AVE. LONG BEACH, CA 90804 | AFLAC | $9K | $550 | $9K | 11.84% |
| KORNELIJA NUMIC3 | 17621 17TH ST. TUSTIN, CA 92780 | AFLAC | $2K | $110 | $2K | 2.30% |
| STEPHANIE A REYNOSO3 Filed as: STEPHANIE A. REYNOSO | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $922 | $110 | $1K | 1.30% |
| MOLOKAI MYLES HAND3 | 3309 WOLFE CT. PLANO, TX 75025 | AFLAC | $476 | — | $476 | 0.60% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY. LAGO VISTA, TX 78645 | AFLAC | $372 | — | $372 | 0.47% |
| MARK H MAZZA3 Filed as: MARK H. MAZZA | 1070 S. RIMWOOD DR. ANAHEIM, CA 92807 | AFLAC | $368 | — | $368 | 0.46% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN M. KIRKLAND | 1270 HOPEWELL CRST. ALPHARETTA, GA 30004 | AFLAC | $241 | — | $241 | 0.30% |
| CASSANDRA GREEN3 | 4341 MARION AVE. CYPRESS, CA 90630 | AFLAC | $175 | — | $175 | 0.22% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN S. HANSON | 5460 E. EL PARQUE ST. LONG BEACH, CA 90815 | AFLAC | $171 | — | $171 | 0.22% |
| LOUIS ORTA3 | 3985 S. SUNRISE AVE. ONTARIO, CA 91761 | AFLAC | $122 | — | $122 | 0.15% |
| KARI S. TAMKE3 | 45 54TH PL. APT. 4 LONG BEACH, CA 90803 | AFLAC | $91 | — | $91 | 0.11% |
| CLAY W CAMPBELL3 Filed as: CLAY W. CAMPBELL | 14720 LIBLEN AVE. BELLFLOWER, CA 90706 | AFLAC | $62 | — | $62 | 0.08% |
| GUSTAVO ARRIAGA II3 | 5237 N. RIVERSIDE DR. SUITE 207 FORT WORTH, TX 76137 | AFLAC | $61 | — | $61 | 0.08% |
| DAWN A CHRISTENSEN3 Filed as: DAWN A. CHRISTENSEN | 24516 APPLE ST. NEWHALL, CA 91321 | AFLAC | $53 | — | $53 | 0.07% |
| GREGOR KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $48 | — | $48 | 0.06% |
| JASON N DOIG3 Filed as: JASON N. DOIG | 1260 W. ADAMS BLVD. LOS ANGELES, CA 90007 | AFLAC | $39 | — | $39 | 0.05% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH A. BUZZELLO | 14747 N. NORTHSIGHT BLVD. SUITE 111-454 SCOTTSDALE, AZ 85260 | AFLAC | $33 | — | $33 | 0.04% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 2211 MICHELSON DR. SUITE 1150 IRVINE, CA 92612 | AFLAC | $31 | — | $31 | 0.04% |
| KAREN M HUGHES3 Filed as: KAREN M. HUGHES | 438 PISGAH PIKE PULSAKI, TN 38478 | AFLAC | $25 | — | $25 | 0.03% |
| AUSTIN MICHAEL DOUGHERTY3 | 9304 FREEDOM RD. UNIT 611 SAPULPA, OK 74066 | AFLAC | $23 | — | $23 | 0.03% |
| JUSTIN M REYNOLDS3 Filed as: JUSTIN M. REYNOLDS | 8433 ENTERPRISE CIR. SUITE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $22 | — | $22 | 0.03% |
| TODD V MASON3 Filed as: TODD V. MASON | 1607 W. PACIFIC COAST HWY APT. 144 WILMINGTON, CA 90744 | AFLAC | $16 | — | $16 | 0.02% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LN. LEXINGTON, KY 40515 | AFLAC | $16 | — | $16 | 0.02% |
| OWEN JOHNSTON3 | 796 N. HART ST. ORANGE, CA 92867 | AFLAC | $16 | — | $16 | 0.02% |
| JOANNA G MATHERLY3 Filed as: JOANNA G. MATHERLY | 2000 GLEN ECHO RD. SUITE 204 NASHVILLE, TN 37215 | AFLAC | $14 | — | $14 | 0.02% |
| MARY ANN KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $13 | — | $13 | 0.02% |
| JEFFORY P MERTEN3 Filed as: JEFFORY P. MERTEN | 906 NW LEWISBURG AVE. CORVALLIS, OR 97330 | AFLAC | $11 | — | $11 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: MATTHEW DOMINIC BROWN | 1259 LOOP 337 SUITE 200 NEW BRAUNFELS, TX 78130 | AFLAC | $11 | — | $11 | 0.01% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DR. WALNUT CREEK, CA 94598 | AFLAC | $9 | — | $9 | 0.01% |
| LIVIER MARIA RAMIREZ3 | 1107 FAIR OAKS AVE. UNIT 882 SOUTH PASADENA, CA 91030 | AFLAC | $8 | — | $8 | 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% |
| GUILLERMO H PALOMINO3 Filed as: GUILLERMO H. PALOMINO | 2319 E. EDNA AVE. PHOENIX, AZ 85022 | AFLAC | $3 | — | $3 | 0.00% |
| DE VITA B MCKENZIE3 Filed as: DE VITA B. MCKENZIE | 300 E. ESPLANADE DR. SUITE 1220 OXNARD, CA 93036 | AFLAC | $2 | — | $2 | 0.00% |
| MEGHAN MOFFATT LUCAS3 Filed as: MEGHAN M. MILLER | 728 MERCER PL. HUNTERSVILLE, NC 28078 | AFLAC | $2 | — | $2 | 0.00% |
| SETH JAFFE3 Filed as: SETH L. JAFFE | 4127 E. MASSACHUSETTS ST. LONG BEACH, CA 90814 | AFLAC | $1 | — | $1 | 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 | 396 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 398 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 394 | $2.1M |
| Dental | BLUE CROSS OF CALIFORNIA | 394 | $1.3M |
| Vision | BLUE CROSS OF CALIFORNIA | 394 | $1.3M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 394 | $1.3M |
| Short-term disability | AFLAC | 64 | $79K |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 394 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 394 | — |
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.