| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES P.O. BOX 4047 CONCORD, CA 94524 | BLUE CROSS OF CALIFORNIA | $28K | $3K | $31K | 3.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $20K | $3K | $23K | 2.55% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE | ADMINISTRATORS INC. 721 S. PARKER STREET ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | — | $22K | $22K | 2.43% |
| BELLEHAVEN MANAGEMENT INC3 Filed as: BELLEHAVEN MANAGEMENT INC. | 248 E. ROWLAND STREET COVINA, CA 91723 | BLUE CROSS OF CALIFORNIA | -$69 | — | -$69 | -0.01% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $190 | $2K | 11.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES 248 E. ROWLAND STREET COVINA, CA 91723 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 5.92% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $266 | $65 | $331 | 1.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $269 | — | $269 | 1.54% |
| DAVID O CHRISTENSEN3 Filed as: DAVID O. CHRISTENSEN | 396 CYPRESS DRIVE APT. F LAGUNA BEACH, CA 92651 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $119 | $74 | $193 | 1.10% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $54 | — | $54 | 0.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $468 | $156 | $624 | 9.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $522 | $43 | $565 | 8.56% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE | ADMINISTRATORS INC. 721 S. PARKER STREET, SUITE 300 ORANGE, CA 92868 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $330 | — | $330 | 5.00% |
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 | 102 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 261 | $895K |
| Dental | BLUE CROSS OF CALIFORNIA | 261 | $895K |
| Vision | BLUE CROSS OF CALIFORNIA | 261 | $895K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 261 | $895K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 25 | $18K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 19 | $7K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 261 | $895K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 261 | $913K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 261 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.