| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $22K | $179 | $22K | 3.15% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE CROSS OF CALIFORNIA | — | $14K | $14K | 2.01% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 | PO BOX 2158 ROSEVILLE, CA 92516 | BLUE CROSS OF CALIFORNIA | — | $464 | $464 | 0.07% |
| LANDMARK BENEFITS INC3 Filed as: LANDMARK INSURANCE, LLC | 5388 EAST MOUNTAIN STREET STONE MOUNTAIN, GA 30083 | HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | $10K | $2K | $12K | 6.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3635 RIVERSIDE PLAZA DRIVE BUILDING M3, SUITE 320 RIVERSIDE, CA 92506 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | — | $4K | 2.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $7K | — | $7K | 9.91% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $455 | $418 | $873 | 3.39% |
| MJ INSURANCE3 Filed as: CLIENT BENEFIT AND VARIOUS AGENTS | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $387 | $34 | $421 | 1.63% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $217 | $59 | $276 | 1.07% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES, INC. | PO BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $225 | $43 | $268 | 1.04% |
| TANA L MAY3 Filed as: TANA L. MAY | 1820 MAY LANE HARRISON, AR 72601 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $159 | $27 | $186 | 0.72% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $130 | $9 | $139 | 0.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 3310 SANTA BARBARA, CA 93130 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $82 | $2 | $84 | 0.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2375 EAST CAMELBACK ROAD PHOENIX, AZ 85016 | DELTA DENTAL PLAN OF ARKANSAS | $2K | — | $2K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 10.02% |
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 | 132 | 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) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 180 | $1.1M |
| Dental(3 contracts, 3 carriers) | HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | 91 | $275K |
| Vision | BLUE CROSS OF CALIFORNIA | 180 | $695K |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 180 | $709K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 180 | $1.1M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 180 | $735K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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.