| 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 | CALIFORNIA PHYSICIANS' SERVICE | — | $71K | $71K | 5.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $66K | $2K | $68K | 5.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | $16K | $26 | $16K | 9.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $969 | $969 | 1.71% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD. SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $830 | $830 | 1.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | — | $7K | 15.00% |
| FMLASOURCE INC3 Filed as: FMLASOURCE INC. | 455 N. CITYFRONT PLZ DR. 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 12.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $788 | $788 | 1.64% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD. SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $676 | $676 | 1.41% |
| MYKISHA L. THOMAS3 | 3886 3RD AVE. LOS ANGELES, CA 90008 | AFLAC | $2K | $172 | $2K | 12.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $854 | — | $854 | 4.27% |
| TALHA ZAQUIR RAHMAN3 | 8811 ELDORADO PKWY. APT. 4101 FRISCO, TX 75033 | AFLAC | $436 | $29 | $465 | 2.33% |
| DAVID HERNANDEZ3 | 2239 W. 190TH ST. TORRANCE, CA 90504 | AFLAC | $16 | — | $16 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $351 | $351 | 1.77% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD. SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $301 | $301 | 1.51% |
| PATRICIA SWANSON4 | 579 W. LEMON AVE. MONROVIA, CA 91016 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $227 | — | $227 | 7.47% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $74 | — | $74 | 2.44% |
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 | 335 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 340 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 187 | $2.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 237 | $165K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 237 | $165K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 335 | $68K |
| Short-term disability | AFLAC | 11 | $20K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 335 | $57K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 137 | $1.3M |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 335 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 335 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.