| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR CREEK DRIVE FULLERTON, CA 92833 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $22K | $22K | 2.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $590 | $590 | 0.07% |
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR WATER CREEK DRIVE FULLERTON, CA 92833 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $19K | — | $19K | 6.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | $137 | $3K | 0.95% |
| GOLDEN FARM INSURANCE INC.3 Filed as: GOLDEN FARM INSURANCE | MARKETING, INC. 1650 CLEAR CREEK DRIVE FULLERTON, CA 928331436 | VISION SERVICE PLAN | $2K | — | $2K | 3.04% |
| TRIAD FINANCIAL INSURANCE MARK3 Filed as: TRIAD INSURANCE GROUP | 18757 BURBANK BLVD. SUITE 303 TARZANA, CA 91356 | VISION SERVICE PLAN | $622 | — | $622 | 1.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 3.50% |
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR CREEK DRIVE FULLERTON, CA 92833 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 3.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 3.50% |
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR CREEK ROAD FULLERTON, CA 92833 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 3.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $982 | — | $982 | 3.50% |
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR CREEK ROAD FULLERTON, CA 92833 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $982 | — | $982 | 3.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $224 | — | $224 | 3.50% |
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR CREEK DRIVE FULLERTON, CA 92833 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $224 | — | $224 | 3.50% |
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 | 284 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 288 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 284 | $884K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 284 | $310K |
| Vision | VISION SERVICE PLAN | 279 | $58K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 298 | $28K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 298 | $45K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 298 | $41K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 284 | $884K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 298 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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."
No prospect flags tripped on this filing.