| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HEALTH NET | $73K | — | $73K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $39K | $1K | $40K | 4.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | SUN LIFE ASSURANCE COMPANY OF CANADA | $25K | $236 | $25K | 7.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 91102 | SUN LIFE ASSURANCE COMPANY OF CANADA | $12K | — | $12K | 3.54% |
| SYNERGY ENROLLMENT AND BENEFITS LLC3 Filed as: SYNERGY ENROLLMENT & BENEFITS LLC | 9370 SKY PARK CT. SUITE 250 SAN DIEGO, CA 92123 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 2.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | SUN LIFE ASSURANCE COMPANY OF CANADA | $785 | — | $785 | 0.23% |
| KANDRA KING4 | 1640 MORSE DR. SAN PEDRO, CA 90732 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $198 | — | $198 | 8.75% |
| IMA, INC.4 Filed as: IMA CORP. | 1705 17TH ST. DENVER, CO 80202 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $104 | — | $104 | 4.60% |
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 | 321 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NET | 138 | $2.3M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 324 | $346K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 324 | $346K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 324 | $346K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 324 | $346K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 324 | $346K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH NET | 138 | $2.3M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 324 | $348K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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.