| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $43K | $2K | $45K | 5.42% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $17K | $17K | 2.05% |
| GOREHAM-MOORE AND ASSOCIATES INC.3 | 5405 MOREHOUSE DRIVE, SUITE 340 SAN DIEGO, CA 92121 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC | $16K | $194 | $16K | 5.07% |
| KAREN A WILSON3 Filed as: KAREN A. WILSON | PO BOX 886 TEMPLETON, CA 93465 | AFLAC | $6K | $516 | $6K | 11.71% |
| THERESA E GOMEZ3 Filed as: THERESA E. GOMEZ | 9815 STEELHEAD ROAD PASO ROBLES, CA 93446 | AFLAC | $1K | $103 | $1K | 2.33% |
| ERNESTO GONZALEZ3 Filed as: ERNESTO CONZALEZ INS. SERVICES CORP | 310 JAMES WAY, SUITE150 PISMO BEACH, CA 93449 | AFLAC | $525 | $103 | $628 | 1.15% |
| D BREDESON INSURANCE SERVICES INC3 Filed as: D BREDESON INSURANCE SERVICES, INC. | 641 HIGUERA STREET, SUITE 300 SAN LUIS OBISPO, CA 93401 | AFLAC | $200 | $103 | $303 | 0.56% |
| LESTER RAY BLACKSHEAR3 | 892 UNION STATION PARKWAY SUITE 8231 LEWISVILLE, TX 75057 | AFLAC | $258 | — | $258 | 0.47% |
| MJ INSURANCE3 Filed as: MARK A MUELLER AND VARIOUS AGENTS | 4145 SHADOW LANE APARTMENT 413 SANTA ROSA, CA 95405 | AFLAC | $209 | — | $209 | 0.38% |
| KAREN LEE LINDSEY3 Filed as: KAREN LEE LINDSAY | 4465 NOTTINGHAM DRIVE SANTA MARIA, CA 93455 | AFLAC | $188 | — | $188 | 0.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92501 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
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 | 168 | 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) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 184 | $1.2M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 184 | $835K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 184 | $835K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 184 | $845K |
| Prescription drug(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 184 | $1.2M |
| Other(3 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 184 | $899K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.