| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $68K | $1K | $70K | 3.53% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | BLUE CROSS OF CALIFORNIA | $23K | — | $23K | 1.16% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 | 4371 LATHEM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 0.07% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 | 3010 LAVA RIDGE COURT, SUITE 110 ROSEVILLE, CA 95661 | BLUE CROSS OF CALIFORNIA | — | $264 | $264 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $5K | $9K | 4.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.16% |
| HUB INTERNATIONAL MIDWEST LIMITED0 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2393 TOWNSGATE ROAD, SUITE 101 WEST LAKE VILLIAGE, CA 91361 | AFLAC | $8K | $58 | $8K | 14.42% |
| DINORAH ROSSANA DEVALLY3 | 361 MISTY TRAILS PLACE SIMI VALLEY, CA 93065 | AFLAC | $6K | — | $6K | 11.12% |
| NASHINA BUSH3 | 16161 VENTURA BOULEVARD, SUITE 421 ENCINO, CA 91436 | AFLAC | $4K | $21 | $4K | 8.11% |
| VICTOR NORDENFLYCHT-DARBY3 Filed as: VICTOR NORDENFLYCHT DARBY | 2459 NORTH BRIGHTON STREET BURBANK, CA 91504 | AFLAC | $3K | $61 | $3K | 6.00% |
| BRIAN G JAEGGI3 Filed as: BRIAN G. JAEGGI | 5112 TOPANGA CANYON BOULEVARD WOODLAND HILLS, CA 91364 | AFLAC | $3K | — | $3K | 4.94% |
| RENEE SUZANNE CORSO3 | 5805 SEPULVEDA BOULEVARD SUITE 740 SHERMAN OAKS, CA 91411 | AFLAC | $1K | — | $1K | 2.75% |
| MJ INSURANCE3 Filed as: PAUL GALLEGOS AND VARIOUS AGENTS | 10519 SHOSHONE AVENUE GRANADA HILLS, CA 91344 | AFLAC | $741 | — | $741 | 1.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $654 | — | $654 | 3.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | VISION SERVICE PLAN | $326 | — | $326 | 1.66% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY | 150 SAWGRASS DIVE ROCHESTER, NY 14620 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $182 | — | $182 | 7.02% |
| EDGEWOOD PARTNERS INSURANCE CENTER3 | 200 ALAMEDA DE LAS PULGAS SAN MATEO, CA 94403 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $113 | — | $113 | 4.36% |
| CALVIN DEAN INGLE3 | 1840 LARIAT TRAIL CELINA, TX 75009 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $88 | — | $88 | 3.39% |
| JOHN D EVANGELISTA3 Filed as: JOHN D EVANGELISTA AND OTHER AGENTS | 29811 SANTA MARGARITA PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $87 | — | $87 | 3.35% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $54 | — | $54 | 2.08% |
| ROSE RODRIQUEZ CUEVAS3 | 1675 SOUTH FRANKWOOD AVENUE REEDLEY, CA 93654 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $38 | — | $38 | 1.46% |
| ADRIANA MENDIETA3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $37 | — | $37 | 1.43% |
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 | 193 | 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) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 373 | $2.0M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 189 | $189K |
| Vision | VISION SERVICE PLAN | 142 | $20K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 373 | $2.0M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 373 | $2.0M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 373 | $2.0M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 373 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 373 | — |
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.