| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $103 | $50K | $50K | 2.98% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 1001 MARK AVENUE SUITE 201 CARPINTERIA, CA 93013 | CALIFORNIA PHYSICIANS' SERVICE | $239 | $16K | $16K | 0.95% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 1001 MARK AVENUE SUITE 201 CARPINTERIA, CA 93013 | CALIFORNIA PHYSICIANS' SERVICE | — | $58 | $58 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 7.26% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 Filed as: EDGEWOOD PARTNERS INS CTR | 3697 MT DIABLO BLVD. SUITE 100 LAFAYETTE, CA 94549 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 2.75% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN INSURANCE SERVICES | 100 RIALTO PLACE SUITE 900 MELBOURNE, FL 32901 | HARTFORD LIFE AND ACCIDENT | — | $325 | $325 | 0.54% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF CALIFORNIA INC. | 1001 MARK AVENUE SUITE 201 CARPINTERIA, CA 93013 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $330 | — | $330 | 3.49% |
| BLUE PACIFIC INSURANCE SERVICES3 | 18 SEPULVEDA RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $251 | — | $251 | 2.65% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC. | 701 B STREET SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $83 | — | $83 | 0.88% |
| CONCIERGE BENEFITS & INSURANCE SERV3 Filed as: CONCIERGE BENEFITS & INS. SVCS. | 3535 LINDA VISTA DRIVE SAN MARCOS, CA 92078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $65 | — | $65 | 0.69% |
| RACHAEL DARLENE DUBE3 | 9 FRANCES BARBER DR. HOPE VALLEY, RI 02832 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | — | $64 | 0.68% |
| CONSUMER DRIVEN BENEFITS LLC3 Filed as: CONSUMER DRIVE BENEFITS LLC | 1301 DOVE ST. NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | — | $62 | 0.66% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.43% |
| RAMONA MARGARET DALY3 | 2877 CALLE HERALDO SAN CLEMENTE, CA 92673 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $40 | — | $40 | 0.42% |
| J&H FINANCIAL AND INSURANCE SVC LLC3 | 22948 VIA CEREZA UNIT 4E MISSION VIEJO, CA 92691 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 0.40% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.26% |
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | ZURICH AMERICAN INSURANCE COMPANY | $395 | — | $395 | 15.01% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 106 | $1.7M |
| Dental | CALIFORNIA PHYSICIANS' SERVICE | 106 | $1.7M |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 106 | $1.7M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 127 | $60K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 9 | $9K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 127 | $60K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 106 | $1.7M |
| Other(4 contracts, 4 carriers) | HARTFORD LIFE AND ACCIDENT | 140 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.