| 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 | CALIFORNIA PHYSICIANS' SERVICE | $59K | — | $59K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 11.08% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $6K | $10K | 11.69% |
| WELLS FARGO INSURANCE SERVICES3 Filed as: WELLS FARGO INSURANCE SERVICES USA | 21250 HAWTHORNE BLVD. TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 6.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 3.74% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $121 | $1K | 1.37% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $680 | $416 | $1K | 1.33% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $3 | $1K | 1.23% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $490 | $36 | $526 | 0.64% |
| BENEFITS COORDINATOR3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $505 | $1 | $506 | 0.62% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $323 | $1 | $324 | 0.39% |
| GRACE V NEAD3 Filed as: GRACE V. NEAD | 1015 STATE PARK RD. GREENVILLE, SC 29609 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $257 | $14 | $271 | 0.33% |
| JACK ALLEN NORRIS3 | 1204 LEXINGTON STREET SUITE 2B IRMO, SC 29063 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $257 | $8 | $265 | 0.32% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST. UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $244 | $3 | $247 | 0.30% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $145 | $36 | $181 | 0.22% |
| BILLY MARK ROBERSON3 | 17415 SHADY CANYON SAN ANTONIO, TX 78248 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | $35 | $126 | 0.15% |
| OMAR MENDOZA3 | 26326 ROCKWALL PKWY. NEW BRAUNFELS, TX 78132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $81 | $35 | $116 | 0.14% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | — | $111 | 0.13% |
| CAMBRIDGE CONSULTING GROUP LLC3 Filed as: CAMBRIDGE FINANCIAL & INSURANCE | GROUP 35 BRENDON WAY, SUITE D GREENVILLE, SC 29615 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $78 | $14 | $92 | 0.11% |
| HORIZON BENEFITS LLC3 | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $42 | $64 | 0.08% |
| SUSAN GOLD STOKES3 Filed as: SUSAN G. STOKES | 3113 W. 187TH PL. TORRANCE, CA 90504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $63 | — | $63 | 0.08% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE ST. LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $56 | — | $56 | 0.07% |
| MANUEL FUENTES3 | 23910 W. INTERSTATE 10 SAN ANTONIO, TX 78257 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $38 | $17 | $55 | 0.07% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST. RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 0.06% |
| CASEY JAMES KUGLER3 | 336 PACIFICA DRIVE BRENTWOOD, CA 94513 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $39 | $51 | 0.06% |
| WILLIAM WAYNE STIGILE3 | 514 GRINDSTONE WOODBRIDGE, CA 95258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $44 | — | $44 | 0.05% |
| JAMES R MCCOMB3 Filed as: JAMES R. MCCOMB | 1063 COATESDALE RD. COLUMBIA, SC 29209 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $41 | — | $41 | 0.05% |
| ELTHON ISRAEL CRUZ3 | 3800 WEST DEVONSHIRE AVENUE HEMET, CA 92545 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.05% |
| ADVANCED BENEFIT SYSTEM INC3 Filed as: ADVANCED BENEFIT SYSTEM INC. | 245 SEVEN FARMS DRIVE DANIEL ISLAND, SC 29492 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $19 | $32 | 0.04% |
| BRIAN ROBERT LLOYD3 | 1781 VINEYARD DR. SUITE 225 ANTIOCH, CA 94509 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $20 | $32 | 0.04% |
| CAROLINA REGIONAL INSURANCE3 | P.O. BOX 8808 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.03% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST. HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.03% |
| BARBARA ANN BASTON3 | 5401 MANSEL LANE FT. WORTH, TX 76134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.03% |
| GABRIEL HOLGUIN3 | 2807 GRATTON ST. RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.03% |
| SA GENERAL AGENCY INC3 Filed as: SA GENERAL AGENCY INC. | 9385 MILLER LANE GARDEN RIDGE, TX 78266 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $15 | $20 | 0.02% |
| SOFIA ASHLEY SIMCOX3 | 1049 COVERDALE LN. DESOTO, TX 75115 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.02% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $4 | $16 | 0.02% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER CT. MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.02% |
| JORGE ALEJANDRO MONTEMAYOR3 | 10702 N. 23RD LANE MCALLEN, TX 78504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.01% |
| DOMINGO MUNOZ3 | P.O. BOX 775 CHARLOTTE, TX 78011 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $14K | — | $14K | 58.75% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | THE PAUL REVERE LIFE INSURANCE COMPANY | $202 | $191 | $393 | 19.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | THE PAUL REVERE LIFE INSURANCE COMPANY | $207 | — | $207 | 10.10% |
| DAVID J ROBERTS3 Filed as: DAVID J. ROBERTS | 167 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $187 | $12 | $199 | 9.71% |
| STEPHEN JOSEPH JOYCE3 | 70 SARGENT DR. AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $15 | $8 | $23 | 1.12% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | — | $16 | 0.78% |
| KARL L FONDA3 Filed as: KARL L. FONDA | 311 BROOKSBORO DR. WEBSTER, NY 14580 | THE PAUL REVERE LIFE INSURANCE COMPANY | $15 | — | $15 | 0.73% |
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 | 502 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 502 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 89 | $1.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 275 | $136K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 211 | $24K |
| Life insurance(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 275 | $220K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 101 | $84K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 211 | $24K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 89 | $1.2M |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 275 | $220K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.