| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $51K | $12K | $62K | 5.68% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD AND BROWN INSURANCE | ADMINISTRATORS INC. 721 S. PARKER STREET ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | — | $31K | $31K | 2.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | PRINCIPAL LIFE INSURANCE COMPANY | $14K | — | $14K | 11.61% |
| JENNIFER AURORA RAMIREZ3 | 1053 FICUS LANE SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $871 | $421 | $1K | 13.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $601 | $141 | $742 | 7.63% |
| LILIANA RIVERA3 | 25671 TONADILLA CIRCLE MORENO VALLEY, CA 92551 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $252 | $26 | $278 | 2.86% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $137 | $64 | $201 | 2.07% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $111 | $41 | $152 | 1.56% |
| MARGARITA ALEJANDRA RAMIREZ3 | 1356 CALLE COLNETT SAN MARCOS, CA 92069 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $117 | $34 | $151 | 1.55% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $121 | $28 | $149 | 1.53% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $105 | — | $105 | 1.08% |
| CASEY JAMES KUGLER3 | 906 HAWKS FEATHER LANE ROCKLIN, CA 95765 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $71 | $88 | 0.90% |
| BRIAN ROBERT LLOYD3 | 3053 COPPERWOOD WAY EL DORADO HILLS, CA 95762 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | $57 | $74 | 0.76% |
| BRETT WELTY INSURANCE AGENCY INC3 Filed as: BRETT WELTY INSURANCE AGENCY INC. | 10769 WOODSIDE AVENUE SANTEE, CA 92071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $72 | — | $72 | 0.74% |
| JB CREATIVE SOLUTIONS LLC3 | 3881 FREEMAN WAY PROSPER, TX 75078 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $23 | $5 | $28 | 0.29% |
| LORI LAINE3 Filed as: LORI LANE | 35837 CARTER STREET YUCAIPA, CA 92399 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | — | $25 | 0.26% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP CA INSURANCE SERVICES INC. | 3470 MT. DIABLO BLVD. LAFAYETTE, CA 94549 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.17% |
| BRUCE W BUSSER3 Filed as: BRUCE W. BUSSER | 22461 SAN JOAQUIN DRIVE WEST CANYON LAKE, CA 92587 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
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 | 166 | 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) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 207 | $1.1M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 245 | $123K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 245 | $123K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 245 | $133K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 71 | $10K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 245 | $123K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 245 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.