| 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 | $406K | $218 | $406K | 4.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $82K | $3K | $84K | 10.33% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 1105 NORTH MARKET STREET SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $19K | — | $19K | 2.34% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 SOUTH THIRD STREET SUITE 800 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 0.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $3K | — | $3K | 2.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 10.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS, LLC | 1850 GATEWAY DR., SUITE 600 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 1.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | — | $9K | 10.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS, LLC | 1850 GATEWAY DR., SUITE 600 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 1.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 10.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $1K | $1K | 1.38% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INSURANCE | 1850 GATEWAY DR., SUITE 600 SAN MATEO, CA 94404 | FOUR EVER LIFE INS CO. | $3K | $2K | $5K | 12.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $1K | — | $1K | 3.43% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS, LLC | 1850 GATEWAY DRIVE SUITE 600 SAN MATEO, CA 944044060 | KAISER FOUNDATION HEALTH PLAN INC. | $257 | $249 | $506 | 1.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS, LLC | 1850 GATEWAY DR., SUITE 600 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $361 | $361 | 1.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $6 | — | $6 | 10.34% |
| GREGORY S GOLUB3 Filed as: GREGORY GOLUB | 1850 GATEWAY DR., SUITE 600 SAN MATEO, CA 94404 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $1 | $1 | 1.72% |
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 | 924 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 944 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 923 | $8.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 867 | $815K |
| Vision | VISION SERVICE PLAN | 828 | $128K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 923 | $8.5M |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 919 | $78K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 920 | $88K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 923 | $8.4M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 923 | $8.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 923 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.