| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $432K | — | $432K | 4.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $100K | $21K | $121K | 12.09% |
| ASSUREX3 Filed as: ASSUREX AGENCY INC. | 175 SOUTH THIRD STREET SUITE 800 COLUMBUS, OH 43215 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 0.30% |
| 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 | $800 | — | $800 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 5.36% |
| KEITH HALE3 | 2430 CAMINO RAMON SUITE 114 SAN RAMON, CA 945834212 | KAISER FOUNDATION HEALTH PLAN INC. | -$385 | — | -$385 | -0.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | $2K | $16K | 11.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $3K | — | $3K | 2.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $1K | $10K | 11.42% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INSURANCE | 1850 GATEWAY DR. SUITE 600 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $26 | — | $26 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | $1K | $9K | 11.34% |
| 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 | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | FOUR EVER LIFE INS CO. | $3K | $2K | $5K | 12.00% |
| ANTHEM INSURANCE COMPANIES, INC.0 Filed as: ANTHEM INSURANCE COMPANY | 120 MONUMENT CIR. INDIANAPOLIS, IN 46204 | 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 | 3.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $362 | $2K | 11.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $359 | — | $359 | 10.01% |
| STEVEN STARRATT JR.3 | 1825 DOLPHIN CT. DISCOVERY BAY, CA 94505 | AFLAC | $179 | — | $179 | 5.23% |
| DAVID SCOTT MANCHESTER3 Filed as: DAVID MANCHESTER | 6104 SE HENDERSON ST. PORTLAND, OR 97206 | AFLAC | $97 | — | $97 | 2.84% |
| GREGOR KREMENLIEV3 | 2635 RYAN RD. CONCORD, CA 94518 | AFLAC | $41 | — | $41 | 1.20% |
| JON P BATES JR3 Filed as: JON BATES JR. | 440 REGENTS PARK DR. VALLEJO, CA 94591 | AFLAC | $27 | — | $27 | 0.79% |
| JUSTIN M REYNOLDS3 Filed as: JUSTIN REYNOLDS | 8433 ENTERPRISE CIR. SUITE 100 LAKEWOOD RANCH, FL 34202 | AFLAC | $14 | — | $14 | 0.41% |
| MICHAEL RHODD3 | 2818 ROCKVILLE RD. FAIRFIELD, CA 94534 | AFLAC | $12 | — | $12 | 0.35% |
| ALLISON FARRIS WENDELBERGER3 | 1839 YGNACIO VALLEY RD. SUITE 393 WALNUT CREEK, CA 94598 | AFLAC | $6 | — | $6 | 0.18% |
| KATHRYN HUSTON3 | 2731 BONIFACIO ST. CONCORD, CA 94519 | AFLAC | $4 | — | $4 | 0.12% |
| LAUREL NICOLE HARMS3 Filed as: LAUREL HARMS | 334 STEVEN CIRCLE BENICIA, CA 94510 | AFLAC | $3 | — | $3 | 0.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4 | — | $4 | 6.56% |
| GREGORY S GOLUB3 Filed as: GREGORY GOLUB | 1850 GATEWAY DR., SUITE 600 SAN MATEO, CA 94404 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $2 | — | $2 | 3.28% |
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 | 775 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 812 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 772 | $10.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 748 | $1.0M |
| Vision | VISION SERVICE PLAN | 716 | $131K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 779 | $10.2M |
| Short-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 791 | $86K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 792 | $83K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 772 | $10.0M |
| Other(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 779 | $10.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 792 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.