| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CALIFORNIA CHOICE | $40K | — | $40K | 5.06% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10K | $1K | $11K | 12.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | — | $4K | 4.71% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $4K | 4.14% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $855 | $3K | 3.21% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 9301 NW 33RD ST. DORAL, FL 33172 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $607 | $2K | 2.45% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $37 | $2K | 1.92% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CA INSURANCE SERVICES INC. | 3470 MT. DIABLO BLVD. LAFAYETTE, CA 94549 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $56 | $2K | 1.76% |
| BRETT WELTY INSURANCE AGENCY INC3 Filed as: BRETT WELTY INSURANCE AGENCY INC. | 10769 WOODSIDE AVE. SANTEE, CA 92071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $73 | $1K | 1.54% |
| LORI LAINE3 | 35837 CARTER ST. YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $352 | $21 | $373 | 0.42% |
| LILIANA RIVERA3 | 25671 TONADILLA CIR. MORENO VALLEY, CA 92551 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $225 | $13 | $238 | 0.27% |
| BRIAN YERVANT AKIAN3 | P.O. BOX 17269 IRVINE, CA 92623 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $175 | $23 | $198 | 0.22% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PKWY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.02% |
| BRUCE W BUSSER3 Filed as: BRUCE W. BUSSER | 22461 SAN JOAQUIN DRIVE WEST CANYON LAKE, CA 92587 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.01% |
| ROGER STUART KENCHEL3 | 2588 EL CAMINO REAL CARLSBAD, CA 92008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.00% |
| MARIA LOURDES MENDOZA3 | 26443 SAND PALM CT. MORENO VALLEY, CA 92555 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.00% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 911076024 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | $1K | $10K | 13.48% |
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 | 150 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 150 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA CHOICE | 128 | $783K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 204 | $72K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 204 | $72K |
| Life insurance(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 204 | $161K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 85 | $89K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 204 | $72K |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 204 | $161K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.