| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIV 3 INS & FIN SVCS INC3 Filed as: DIV. 3 INS. & FIN. SVCS. INC. | 200 N. MARYLAND AVE. SUITE 301 GLENDALE, CA 91206 | CALIFORNIA PHYSICIANS' SERVICE | $172K | $127 | $173K | 3.72% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | 701 S. PARKER ST. 8TH FLOOR ORANGE, CA 92868 | CALIFORNIA PHYSICIANS' SERVICE | — | $93K | $93K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $85K | — | $85K | 1.84% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE | ADMINISTRATORS 721 S. PARKET ST., SUITE 300 ORANGE, CA 92868 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $7K | $16K | 8.98% |
| DIVISION 3 INSURANCE & FINANCIAL3 | 200 N. MARYLAND AVE. SUITE 301 GLENDALE, CA 91203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 5.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $1K | $4K | 2.05% |
| DIVISION 3 INSURANCE & FINANCIAL3 | 200 N. MARYLAND AVE. SUITE 301 GLENDALE, CA 91203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 10.94% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE | ADMINISTRATORS 721 S. PARKET ST., SUITE 300 ORANGE, CA 92868 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $1K | $3K | 9.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $262 | $2K | 6.77% |
| DIV 3 INS & FIN SVCS INC3 Filed as: DIV. 3 INS. & FIN. SVCS. INC. | 200 N. MARYLAND AVENUE SUITE 301 GLENDALE, CA 91206 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $20 | — | $20 | 4.65% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN | 701 S. PARKER ST. 8TH FLOOR ORANGE, CA 92868 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | — | $9 | $9 | 2.09% |
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 | 548 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 556 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 921 | $4.6M |
| Dental | CALIFORNIA PHYSICIANS' SERVICE | 921 | $4.6M |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 921 | $4.6M |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 572 | $200K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 572 | $173K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 572 | $173K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 921 | $4.6M |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 572 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 921 | — |
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.