| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | — | $91K | $91K | 4.83% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $68K | $25 | $68K | 4.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | $13K | — | $13K | 7.43% |
| 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') | $4K | — | $4K | 2.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $11K | $4K | $15K | 20.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $4K | $14K | 20.63% |
| FMLASOURCE INC5 Filed as: FMLASOURCE INC. | 455 N. CITYFRONT PLZ DR. 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 8.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 21.28% |
| MYKISHA L. THOMAS3 Filed as: MYKISHA L. BUTLER | 3886 3RD AVE. LOS ANGELES, CA 90008 | AFLAC | $2K | — | $2K | 13.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AFLAC | $977 | $56 | $1K | 6.22% |
| DAVID HERNANDEZ3 | 2239 W. 190TH ST. TORRANCE, CA 90504 | AFLAC | $350 | — | $350 | 2.11% |
| ISAAC SANDOVAL3 | 23630 MAIN ST. CARSON, CA 90745 | AFLAC | $318 | — | $318 | 1.91% |
| JOSHUA LEWIS GOODLOE3 | 424 N. BROADWAY UNIT D REDONDO BEACH, CA 90277 | AFLAC | $190 | — | $190 | 1.14% |
| TALHA ZAQUIR RAHMAN3 | 10973 PRESCOTT DR. FRISCO, TX 75033 | AFLAC | $110 | — | $110 | 0.66% |
| HUY DUC NGUYEN3 | 1915 W. 182ND ST. TORRANCE, CA 90504 | AFLAC | $106 | — | $106 | 0.64% |
| BRANDON TYLOR-DA SHIRLEY3 | 5110 S. SHERBOURNE DR. LOS ANGELES, CA 90056 | AFLAC | $82 | — | $82 | 0.49% |
| ANA FRANCIS CORDOVA3 | 14427 CERISE AVE. APT. 20 HAWTHORNE, CA 90250 | AFLAC | $27 | — | $27 | 0.16% |
| PATRICIA SWANSON4 | 579 W. LEMON AVE. MONROVIA, CA 91016 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $130 | — | $130 | 9.40% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $37 | — | $37 | 2.68% |
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 | 362 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 362 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 186 | $3.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 263 | $178K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES ('CIGNA') | 263 | $178K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $88K |
| Short-term disability | AFLAC | 15 | $17K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $72K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 186 | $3.3M |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 359 | — |
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.