| 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 | $87K | $7K | $94K | 6.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $36K | — | $36K | 4.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 4.51% |
| CARIE ANN CASSAR3 Filed as: CARIE CASSAR | 5615 E. SORRENTO DRIVE LONG BEACH, CA 90803 | AFLAC | $5K | $150 | $5K | 7.21% |
| KORNELIJA NUMIC3 | 17621 17TH STREET APT. 27B TUSTIN, CA 92780 | AFLAC | $3K | $35 | $3K | 3.83% |
| STEPHANIE A REYNOSO3 Filed as: STEPHANIE REYNOSO | 21 CERVANTES NEWPORT BEACH, CA 92660 | AFLAC | $686 | $38 | $724 | 1.03% |
| MOLOKAI MYLES HAND3 | 3309 WOLFE COURT PLANO, TX 75025 | AFLAC | $418 | — | $418 | 0.59% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY. LAGO VISTA, TX 78645 | AFLAC | $358 | — | $358 | 0.51% |
| MARK H MAZZA3 Filed as: MARK MAZZA | 1070 S. RIMWOOD DRIVE ANAHEIM, CA 92807 | AFLAC | $251 | — | $251 | 0.36% |
| COLLEEN M KIRKLAND3 Filed as: COLLEEN KIRKLAND | 1270 HOPEWELL CREST ALPHARETTA, GA 30004 | AFLAC | $188 | — | $188 | 0.27% |
| KATHLEEN S HANSON3 Filed as: KATHLEEN HANSON | 5460 E. EL PARQUE STREET LONG BEACH, CA 90815 | AFLAC | $181 | — | $181 | 0.26% |
| DENISE M. AVILA WALKER3 Filed as: DENISE AVILA WALKER | 2605 ADELITA DRIVE HACIENDA HEIGHTS, CA 91745 | AFLAC | $164 | $15 | $179 | 0.25% |
| CASSANDRA GREEN3 | 4276 KATELLA AVENUE SUITE 185 LOS ALAMITOS, CA 90720 | AFLAC | $122 | — | $122 | 0.17% |
| KARI S. TAMKE3 | 45 54TH PLACE APT. 4 LONG BEACH, CA 90803 | AFLAC | $99 | — | $99 | 0.14% |
| GUSTAVO ARRIAGA II3 | 320 W. CORK TREE DRIVE ORANGE, CA 92865 | AFLAC | $58 | — | $58 | 0.08% |
| DAWN A CHRISTENSEN3 Filed as: DAWN CHRISTENSEN | 24516 APPLE STREET NEWHALL, CA 91321 | AFLAC | $57 | — | $57 | 0.08% |
| CLAY W CAMPBELL3 Filed as: CLAY CAMPBELL | 14720 LIBLEN AVENUE BELLFLOWER, CA 90706 | AFLAC | $53 | — | $53 | 0.08% |
| GREGOR KREMENLIEV3 | 2635 RYAN ROAD CONCORD, CA 94518 | AFLAC | $52 | — | $52 | 0.07% |
| JOSEPH A BUZZELLO3 Filed as: JOSEPH BUZZELLO | 14747 N. NORTHSIGHT BLVD. SUITE 111-454 SCOTTSDALE, CA 85260 | AFLAC | $36 | — | $36 | 0.05% |
| JASON N DOIG3 Filed as: JASON N. DOIG | 1260 W. ADAMS BLVD. LOS ANGELES, CA 90007 | AFLAC | $32 | — | $32 | 0.05% |
| MARCI MARIE OTIS3 Filed as: MARCI OTIS | 200 JULINA LANE ROSEBURG, OR 97471 | AFLAC | $32 | — | $32 | 0.05% |
| JAN MARIE3 | P.O. BOX 3231 COEUR D ALENE, ID 83816 | AFLAC | $30 | — | $30 | 0.04% |
| BARRY MCPHERSON INC3 Filed as: BARRY MCPHERSON INC. | 3928 IRONBARK WAY MCKINNEY, TX 75071 | AFLAC | $25 | — | $25 | 0.04% |
| JUSTIN M REYNOLDS3 Filed as: JUSTIN REYNOLDS | 8433 ENTERPRISE CIRCLE SUITE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $24 | — | $24 | 0.03% |
| CAROL A. KENYON3 Filed as: CAROL KENYON | 1645 CLEVELAND HILL ROAD ROSEBURG, OR 97471 | AFLAC | $21 | — | $21 | 0.03% |
| KAREN M HUGHES3 Filed as: KAREN HUGHES | 438 PIGAH PIKE PULASKI, TN 38478 | AFLAC | $21 | — | $21 | 0.03% |
| AUSTIN MICHAEL DOUGHERTY3 Filed as: AUSTIN DOUGHERTY | 9304 FREEDOM ROAD UNIT 611 SAPULPA, OK 74066 | AFLAC | $21 | — | $21 | 0.03% |
| LOUIS ORTA3 | 3985 S. SUNRISE AVENUE ONTARIO, CA 91761 | AFLAC | $18 | — | $18 | 0.03% |
| TODD V MASON3 Filed as: TODD MASON | 1607 W. PACIFIC COAST HIGHWAY APT. 144 WILIMINGTON, CA 90744 | AFLAC | $17 | — | $17 | 0.02% |
| JOANNA G MATHERLY3 Filed as: JOANNA MATHERLY | 2000 GLEN ECHO ROAD SUITE 204 NASHVILLE, TN 37215 | AFLAC | $14 | — | $14 | 0.02% |
| MARY ANN KREMENLIEV3 | 2635 RYAN ROAD CONCORD, CA 94518 | AFLAC | $14 | — | $14 | 0.02% |
| OWEN JOHNSTON3 | 1231 W. 2ND STREET SANTA ANA, CA 92703 | AFLAC | $14 | — | $14 | 0.02% |
| DALE I DAVIS3 Filed as: DALE DAVIS | 5892 CEDARCREEK LANE LEXINGTON, KY 40515 | AFLAC | $14 | — | $14 | 0.02% |
| JEFFORY MERTEN3 | 906 NW LEWISBURG AVENUE CORVALLIS, OR 97330 | AFLAC | $12 | — | $12 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: MATTHEW BROWN | 1919 FAIRMOUNT AVENUE SW SEATTLE, WA 98126 | AFLAC | $10 | — | $10 | 0.01% |
| ALLISON FARRIS WENDELBERGER3 | 207 SANTA FE DRIVE WALNUT CREEK, CA 94598 | AFLAC | $10 | — | $10 | 0.01% |
| GUY R SOUTER3 Filed as: GUY SOUTER | P.O. BOX 1286 LA PINE, OR 97739 | AFLAC | $9 | — | $9 | 0.01% |
| LIVIER MARIA RAMIREZ3 Filed as: LIVIER RAMIREZ | 1107 FAIR OAKS AVENUE UNIT 882 SOUTH PASADENA, CA 91030 | AFLAC | $7 | — | $7 | 0.01% |
| ANA ARRIAGA3 | 980 ARLINGTON CIRCLE WOODLAND, CA 95695 | AFLAC | $6 | — | $6 | 0.01% |
| HENRY SAUCEDA3 | 2268 ALPHA CIRCLE LA VERNE, CA 91750 | AFLAC | $5 | — | $5 | 0.01% |
| JODY L WALK3 Filed as: JODY WALK | 35689 ROSE MOSS AVENUE LEESBURG, FL 34788 | AFLAC | $5 | — | $5 | 0.01% |
| TERRY K ALLEN3 Filed as: TERRY ALLEN | 20930 E. HAPPY TRAILS LANE OTIS ORCHARDS, WA 99027 | AFLAC | $5 | — | $5 | 0.01% |
| LISA HALL3 | 686 W. MOGUL LOOP APT. 102 HAYDEN, ID 83835 | AFLAC | $4 | — | $4 | 0.01% |
| JEROMY E. CILLEY3 Filed as: JEROMY CILLEY | 2683 E. WILSHIRE DRIVE EUGENE, OR 97405 | AFLAC | $4 | — | $4 | 0.01% |
| KAREN PICCININI3 Filed as: KAREN BALL | 11683 E. EMERALD DRIVE HAYDEN, ID 83835 | AFLAC | $3 | — | $3 | 0.00% |
| GUILLERMO H PALOMINO3 Filed as: GUILLERMO PALOMINO | 14224 N. 26TH DRIVE PHOENIX, AZ 85023 | AFLAC | $3 | — | $3 | 0.00% |
| DARAN L WYCKOFF3 Filed as: DARAN WYCKOFF | P.O. BOX 31233 SPOKANE, WA 99223 | AFLAC | $2 | — | $2 | 0.00% |
| DE VITA B MCKENZIE3 Filed as: DE VITA MCKENZIE | 1139 IROLO STREET LOS ANGELES, CA 90006 | AFLAC | $2 | — | $2 | 0.00% |
| MEGHAN MILLER3 | 149 MALIBU ROAD MOORESVILLE, NC 28117 | AFLAC | $2 | — | $2 | 0.00% |
| SHANE EDMUND ATTEBERY3 Filed as: SHANE ATTEBERY | 391 RANDY DRIVE GRANTS PASS, OR 97527 | AFLAC | $1 | — | $1 | 0.00% |
| IOANNIS T GRATSINOPOULOS3 Filed as: IOANNIS GRATSINOPOULOS | 1893 E. DAULBY STREET MERIDIAN, ID 83642 | AFLAC | $1 | — | $1 | 0.00% |
| RAYMON P KEECH III3 Filed as: RAYMON KEECH III | 8207 CAMPAIGN CIRCLE RICHMOND, TX 77406 | AFLAC | $1 | — | $1 | 0.00% |
| SETH JAFFE3 | 4127 E. MASSACHUSETTS STREET LONG BEACH, CA 90814 | AFLAC | $1 | — | $1 | 0.00% |
| TAYLOR INSURANCE, INC.3 Filed as: TAYLOR INSURANCE INC. | P.O. BOX 171 SANDPOINT, ID 83864 | 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 | 15.23% |
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 | 459 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 463 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 533 | $2.4M |
| Dental | BLUE CROSS OF CALIFORNIA | 533 | $1.5M |
| Vision | BLUE CROSS OF CALIFORNIA | 533 | $1.5M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 533 | $1.5M |
| Short-term disability | AFLAC | 56 | $71K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 533 | $2.4M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 533 | $1.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 533 | — |
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.