| 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 | CIGNA HEALTHCARE OF CALIFORNIA | $62K | — | $62K | 3.69% |
| POLENZANI BENEFITS & INSURANCE3 Filed as: POLENZANI BENEFITS & INS. SERVICES | 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | CIGNA HEALTHCARE OF CALIFORNIA | $19K | — | $19K | 1.14% |
| POLENZANI BENEFITS & INSURANCE3 Filed as: POLENZANI BENEFITS & INS. SERVICES | 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | KAISER FOUNDATION HEALTH PLAN INC. | $43K | — | $43K | 2.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | KAISER FOUNDATION HEALTH PLAN INC. | $19K | — | $19K | 1.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $39K | — | $39K | 5.26% |
| POLENZANI BENEFITS & INSURANCE3 Filed as: POLENZANI BENEFITS & INS. SERVICES | 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $15K | — | $15K | 2.06% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $8K | $122 | $8K | 17.67% |
| ASSURANCE AGENCY LTD3 Filed as: AMERICAN FIDELITY ASSURANCE COMPANY | P.O. BOX 25360 OKLAHOMA CITY, OK 73125 | AMERICAN FIDELITY ASSURANCE COMPANY | $4K | — | $4K | 12.87% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $6K | — | $6K | 33.60% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $6K | $20 | $6K | 46.25% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $5K | — | $5K | 45.68% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $5K | $8 | $5K | 51.45% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $3K | — | $3K | 50.34% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 43.01% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 47.58% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 46.58% |
| VARIOUS - SEE ATTACHED3 | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $1K | $11 | $1K | 44.41% |
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 | 726 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 733 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTHCARE OF CALIFORNIA | 588 | $4.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 588 | $743K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 588 | $743K |
| Life insurance(10 contracts) | AFLAC | 69 | $122K |
| Short-term disability(11 contracts, 2 carriers) | AFLAC | 69 | $150K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 20 | $28K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 588 | $2.4M |
| Other(11 contracts, 2 carriers) | AFLAC | 69 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 588 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.