| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | KAISER FOUNDATION HEALTH PLAN INC. | — | $288 | $288 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | HEALTH NET | — | $838 | $838 | 0.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $2K | $5K | 7.32% |
| MARIA LOURDES MENDOZA3 Filed as: MARIA L. MENDOZA | 26443 SAND PALM CT. MORENO VALLEY, CA 92555 | AMERICAN HERITAGE LIFE INSURANCE | $4K | — | $4K | 13.01% |
| VAN NOY INS. & FINANCIAL SVCS, INC.3 | 7168 ARCHIBALD AVENUE, SUITE 280 ALTA LOMA, CA 91701 | AMERICAN HERITAGE LIFE INSURANCE | $2K | — | $2K | 6.91% |
| EDWARD S. RICE JR.3 | 4050 KATELLA AVENUE, SUITE 213 LOS ALAMITOS, CA 90720 | AMERICAN HERITAGE LIFE INSURANCE | $398 | — | $398 | 1.33% |
| SALVADOR SANCHEZ3 | 10231 STANFORD AVENUE SOUTH GATE, CA 90280 | AMERICAN HERITAGE LIFE INSURANCE | $67 | — | $67 | 0.22% |
| ROGERS BENEFIT GROUP INC3 Filed as: STEPHEN W. ROGERS | 1552 COLUMBINE WAY UPLAND, CA 91786 | AMERICAN HERITAGE LIFE INSURANCE | $64 | — | $64 | 0.21% |
| ROBERT A. CORLETTE3 | 1015 RIDGELINE ROAD ORANGE, CA 92869 | AMERICAN HERITAGE LIFE INSURANCE | $43 | — | $43 | 0.14% |
| EDGAR V. AGUILAR3 | P.O. BOX 4108 SAN CLEMENTE, CA 92674 | AMERICAN HERITAGE LIFE INSURANCE | $17 | — | $17 | 0.06% |
| DUANE M. BAUTISTA3 | 6 CANDLEWOOD LANE ALISO VIEJO, CA 92656 | AMERICAN HERITAGE LIFE INSURANCE | $13 | — | $13 | 0.04% |
| ART VARTAN KASABIAN3 | 2110 S JACOB STREET VISALIA, CA 93277 | AMERICAN HERITAGE LIFE INSURANCE | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
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 | 156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 99 | $908K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 104 | $72K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 104 | $72K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE | 53 | $43K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 99 | $878K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.