| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVECS, INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | CALIFORNIA PHYSICIANS SERVICE | $85K | $15K | $100K | 5.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN | $13K | $170 | $13K | 4.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2560 PROFESSIONAL PARKWAY SANTA MARIA, CA 93455 | DELTA DENTAL OF CALIFORNIA | $18K | — | $18K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $6K | $13K | 16.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 3010 SANTA BARBARA, CA 93130 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $95 | $2K | 5.41% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $386 | $1K | 5.15% |
| MARIA YVONNE RODIGHIERO3 | 28502 SHRIKE DRIVE LAGUNA NIGUEL, CA 92677 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $596 | $42 | $638 | 2.20% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $456 | $149 | $605 | 2.09% |
| MJ INSURANCE3 Filed as: DOUGLAS NERDAHL AND VARIOUS AGENTS | 41 WEST 4TH AVENUE SAN MATEO, CA 94402 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $526 | $69 | $595 | 2.06% |
| RICHARD C SUTHERLAND III3 Filed as: RICHARD C. SUTHERLAND III | 3601 FIGUEROA STREET GLENDALE, CA 91206 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $414 | $167 | $581 | 2.01% |
| ROSE VILLALON PASQUEL3 | 135 WEST 226TH PLACE CARSON, CA 90745 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $377 | $93 | $470 | 1.62% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | THE PAUL REVERE LIFE INSURANCE COMPANY | $38 | — | $38 | 1.55% |
| JOHN A. BRADLEY INC.3 Filed as: JOHN A. BRADLEY, INC. | 207 SOUTH MAIN STREET FOUNTAIN INN, SC 29644 | THE PAUL REVERE LIFE INSURANCE COMPANY | $18 | — | $18 | 0.74% |
| GLORIA MEKELBURG3 | 3 RIVERVIEW COURT OAKDALE, NY 11769 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | — | $4 | 0.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | VISION SERVICE PLAN | — | — | $0 | — |
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 | 163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 246 | $2.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 300 | $183K |
| Vision(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 246 | $1.7M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 153 | $78K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 153 | $78K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 153 | $78K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 246 | $2.0M |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 163 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 300 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.