| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | $21K | — | $21K | 5.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORK & BROWN | 701 S. PARKER STREET, 8TH FLOOR ORANGE, CA 92868 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | — | -$9 | -$9 | -0.00% |
| BARBARA R SANTELLA3 Filed as: BARBARA SANTELLA | 22344 E. PLYMOUTH CIRCLE AURORA, CO 80016 | AFLAC | $6K | $347 | $6K | 17.98% |
| LINDSAY LIJEWSKI3 | 9034 E. EASTER PL., SUITE 202 CENTENNIAL, CO 80112 | AFLAC | $2K | $69 | $2K | 5.39% |
| REGINA K SANTANGELO3 Filed as: REGINA SANTANGELO | 9034 E. EASTER PL., SUITE 202 CENTENNIAL, CO 80112 | AFLAC | $1K | $69 | $1K | 3.17% |
| JOSE DE LOS SANTOS III3 | 15550 E. COPPER CREEK LANE PARKER, CO 80134 | AFLAC | $18 | — | $18 | 0.05% |
| TINA WAY3 | 15550 E. COPPER CREEK LANE PARKER, CO 80134 | AFLAC | $13 | — | $13 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 25186 HANCOCK AVE., SUITE 200 MURRIETA, CA 92562 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $1K | $4K | 15.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LINITED | 300 N. LASALLE ST., 17TH FLOOR CHICAGO, IL 60654 | PRINCIPAL LIFE INSURANCE COMPANY | — | $639 | $639 | 2.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $2 | — | $2 | 11.76% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | 701 S. PARKER STEET, 8TH FLOOR ORANGE, CA 92868 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | — | -$2 | -$2 | -11.76% |
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 | 119 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 70 | $412K |
| Dental(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 119 | $438K |
| Vision(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 119 | $438K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 119 | $26K |
| Short-term disability | AFLAC | 45 | $34K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 70 | $412K |
| Other(3 contracts, 3 carriers) | AFLAC | 119 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 119 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.