| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $55K | $812 | $56K | 4.77% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BNFIT SVCS & OTHER AGENTS | 21011 WARNER CENTER LANE WOODLAND HILLS, CA 91367 | AFLAC | $149 | — | $149 | 1.56% |
| LISA K ARELLANO3 Filed as: LISA ARELLANO | 2982 SAN FERNANDO STREET MINDEN, NV 89423 | AFLAC | $130 | — | $130 | 1.36% |
| GIABINH NGUYEN3 | 21107 MAYBROOK MANOR LANE RICHMOND, TX 77407 | AFLAC | $111 | — | $111 | 1.16% |
| G SCOTT COOKE3 Filed as: G. SCOTT COOKE | 2832 NE 17TH AVENUE WILTON MANORS, FL 33334 | AFLAC | $99 | — | $99 | 1.04% |
| JONATHAN ALI HAJIMOMEN3 Filed as: JONATHAN HAJIMOMEN | 1561 EAST ORANGETHORPE AVENUE SUITE 200 FULLERTON, CA 92831 | AFLAC | $77 | — | $77 | 0.81% |
| THOMAS A CARMICHAEL3 Filed as: THOMAS GENTZ | 3848 CHERRY BROOK LANE MASON, OH 45040 | AFLAC | $58 | — | $58 | 0.61% |
| KEVIN J MARKEL3 Filed as: KEVIN MARKEL | 1501 EAST ORANGETHORPE AVENUE SUITE 180 FULLERTON, CA 92831 | AFLAC | $52 | — | $52 | 0.54% |
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 | 98 | 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) | 98 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 198 | $1.2M |
| Dental | BLUE CROSS OF CALIFORNIA | 198 | $1.2M |
| Vision | BLUE CROSS OF CALIFORNIA | 198 | $1.2M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 198 | $1.2M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 198 | $1.2M |
| Other | AFLAC | 18 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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."
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.