| 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 | — | $71K | $71K | 5.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | PAN-AMERICAN LIFE INSURANCE COMPANY | $22K | — | $22K | 9.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16K | $8K | $24K | 16.71% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $8 | $2K | 3.48% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BLVD. TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 3.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.30% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL INC | 21250 HAWTHORNE BLVD. TORRANCE, CA 90503 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $974 | — | $974 | 2.16% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $546 | — | $546 | 1.21% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $336 | — | $336 | 0.75% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $326 | $3 | $329 | 0.73% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $291 | — | $291 | 0.65% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $170 | — | $170 | 0.38% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $148 | — | $148 | 0.33% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $144 | — | $144 | 0.32% |
| SALVADOR HEREDIA3 | 700 EL CAMINITO LIVERMORE, CA 94550 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 0.21% |
| JACK ALLEN NORRIS3 | 2439 DUTCH BRAND ROAD COLUMBIA, SC 29210 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 0.21% |
| GRACE V NEAD3 Filed as: GRACE V, NEAD | 1015 STATE PARK ROAD GREENVILLE, SC 29609 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $94 | — | $94 | 0.21% |
| SUSAN GOLD STOKES3 | 17042 PINEHURST LANE UNIT D HUNTINGTON BEACH, CA 92647 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $62 | $1 | $63 | 0.14% |
| JAMES R MCCOMB3 Filed as: JAMES R. MCCOMB | 1063 COATESDALE ROAD COLUMBIA, SC 29209 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.10% |
| ELTHON ISRAEL CRUZ3 | 893 S. 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.08% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.07% |
| ASCENSION BENEFITS ADVISORS3 | 6 POMEGRANATE STREET LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.07% |
| WILLIAM WAYNE STIGILE3 | 514 GRINDSTONE WOODBRIDGE, CA 95258 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.07% |
| ELIZABETH LOUISE FENDER3 | 335 S. EMERSON AVENUE INDIANAPOLIS, IN 46219 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | $4 | $30 | 0.07% |
| CAROLINA REGIONAL INSURANCE3 | P.O. BOX 8808 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | — | $23 | 0.05% |
| LAMBERT MONTALBO3 | 26197 MIRADA STREET HIGHLAND, CA 92346 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.04% |
| BARBARA ANN BASTON3 | 5401 MANSEL LANE FORT WORTH, TX 76134 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.03% |
| JEFFREY LUXENBERG3 | 307 LONGTREE LANE LOGANSPORT, IN 46947 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $1 | $3 | 0.01% |
| JEFFREY D BRINDLE3 Filed as: JEFFREY D. BRINDLE | 10811 LAKEVIEW DRIVE CARMEL, IN 46033 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $3K | $1K | $4K | 13.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | THE PAUL REVERE LIFE INSURANCE COMPANY | $76 | — | $76 | 7.46% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | THE PAUL REVERE LIFE INSURANCE COMPANY | $75 | — | $75 | 7.36% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | THE PAUL REVERE LIFE INSURANCE COMPANY | $20 | — | $20 | 1.96% |
| DAVID J ROBERTS3 Filed as: DAVID J. ROBERTS | 167 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5 | — | $5 | 0.49% |
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 | 216 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 180 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 225 | $141K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 282 | $30K |
| Life insurance(3 contracts, 3 carriers) | PAN-AMERICAN LIFE INSURANCE COMPANY | 225 | $418K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 56 | $45K |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 282 | $30K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 180 | $1.3M |
| Other(4 contracts, 4 carriers) | PAN-AMERICAN LIFE INSURANCE COMPANY | 225 | $419K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 282 | — |
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.