| 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 | $19K | — | $19K | 6.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | — | $3K | 0.90% |
| GOLDEN FARM INSURANCE INC.3 Filed as: GOLDEN FARM INS. MARKETING, INC. | 1650 CLEAR CREEK DRIVE FULLERTON, CA 928331436 | VISION SERVICE PLAN | $3K | — | $3K | 4.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | VISION SERVICE PLAN | -$804 | — | -$804 | -1.38% |
| 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 | $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 DRIVE 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 | $283 | — | $283 | 3.50% |
| GOLDEN FARM INSURANCE INC.3 | 1650 CLEAR CREEK DRIVE FULLERTON, CA 92833 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $283 | — | $283 | 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 | 263 | 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) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 268 | $320K |
| Vision | VISION SERVICE PLAN | 268 | $58K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 263 | $35K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 263 | $55K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 263 | $50K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 263 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 268 | — |
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.