| 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 | — | $67K | $67K | 5.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $18K | $6K | $24K | 14.83% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 21250 HAWTHORNE BLVD. TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | — | $3K | 6.33% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $49 | $2K | 4.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $8 | $2K | 3.78% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $572 | — | $572 | 1.34% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $381 | — | $381 | 0.89% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $347 | $17 | $364 | 0.85% |
| BENEFITS COORDINATOR3 | 10741 LA JARA ST. CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $299 | — | $299 | 0.70% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $179 | — | $179 | 0.42% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE ST. LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $146 | — | $146 | 0.34% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD ST. UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $140 | — | $140 | 0.33% |
| ELIZABETH LOUISE FENDER3 | 335 S. EMERSON AVE. INDIANAPOLIS, IN 46219 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $98 | $4 | $102 | 0.24% |
| SUSAN GOLD STOKES3 | 17042 PINEHURST LN. UNIT D HUNTINGTON BEACH, CA 92647 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $78 | $11 | $89 | 0.21% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $85 | — | $85 | 0.20% |
| JACK ALLEN NORRIS3 | 2439 DUTCH BRAND RD. COLUMBIA, SC 29210 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.19% |
| GRACE V NEAD3 Filed as: GRACE V. NEAD | 1015 STATE PARK RD. GREENVILE, SC 29609 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | — | $80 | 0.19% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $42 | — | $42 | 0.10% |
| JAMES R MCCOMB3 Filed as: JAMES R. MCCOMB | 1063 COATESDALE RD. COLUMBIA, SC 29209 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.09% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE ST. LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.07% |
| ELTHON ISRAEL CRUZ3 | 244 S. 1200 E. PAYSON, UT 84651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $31 | — | $31 | 0.07% |
| WILLIAM WAYNE STIGILE3 | 514 GRINDSTONE WOODBRIDGE, CA 95258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.06% |
| JEFFREY LUXENBERG3 | 307 LONGTREE LANE LOGANSPORT, IN 46947 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $17 | $25 | 0.06% |
| LAMBERT MONTALBO3 | 26197 MIRADA ST. HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | — | $24 | 0.06% |
| CAROLINA REGIONAL INSURANCE3 | P.O. BOX 8808 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 0.05% |
| BARBARA ANN BASTON3 | 5401 MANSEL LANE FT. WORTH, TX 76134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.05% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON ST. RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.04% |
| JEFFREY D BRINDLE3 Filed as: JEFFREY D. BRINDLE | 10811 LAKEVIEW DR. CARMEL, IN 46033 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.02% |
| JORGE ALEJANDRO MONTEMAYOR3 | 10702 N. 23RD LANE MCALLEN, TX 78504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| DOMINGO MUNOZ3 | P.O. BOX 775 CHARLOTTE, TX 78011 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | $496 | $4K | 11.46% |
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 | 319 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 320 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 91 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 244 | $161K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 192 | $33K |
| Life insurance(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 244 | $219K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 68 | $43K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 192 | $33K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 91 | $1.3M |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 244 | $219K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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.