| 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 | HEALTH NET | — | $1K | $1K | 0.45% |
| 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 | $3K | $6K | 8.42% |
| VAN NOY INS. & FINANCIAL SVCS, INC.3 | 7168 ARCHIBALD AVENUE, SUITE 280 ALTA LOMA, CA 91701 | AMERICAN HERITAGE LIFE INSURANCE | $610 | — | $610 | 3.46% |
| MARIA LOURDES MENDOZA3 Filed as: MARIA L. MENDOZA | 26443 SAND PALM CT. MORENO VALLEY, CA 92555 | AMERICAN HERITAGE LIFE INSURANCE | $599 | — | $599 | 3.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN HERITAGE LIFE INSURANCE | $461 | — | $461 | 2.61% |
| SALVADOR SANCHEZ3 | 10231 STANFORD AVENUE SOUTH GATE, CA 90280 | AMERICAN HERITAGE LIFE INSURANCE | $83 | — | $83 | 0.47% |
| ROBERT A. CORLETTE3 | 1015 RIDGELINE ROAD ORANGE, CA 92869 | AMERICAN HERITAGE LIFE INSURANCE | $42 | — | $42 | 0.24% |
| ROGERS BENEFIT GROUP INC3 Filed as: STEPHEN W. ROGERS | 1552 COLUMBINE WAY UPLAND, CA 91786 | AMERICAN HERITAGE LIFE INSURANCE | $40 | — | $40 | 0.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $941 | — | $941 | 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 | 105 | 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) | 106 | 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 | $816K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 110 | $73K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 110 | $73K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE | 30 | $27K |
| Short-term disability | AMERICAN HERITAGE LIFE INSURANCE | 13 | $18K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 99 | $798K |
| Other | AMERICAN HERITAGE LIFE INSURANCE | 13 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | — |
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.