| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $620 | $620 | 0.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | HEALTH NET | $0 | $620 | $620 | 0.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | 600 CORPORATE POINTE, SUITE 600 CULVER CITY, CO 90230 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $4K | $7K | 10.67% |
| WELL-PRO INSURANCE SOLUTIONS INC.3 | 9155 ARCHIBALD AVENUE, SUITE H RANCHO CUCAMONGA, CA 91730 | AMERICAN HERITAGE LIFE INSURANCE | $5K | $0 | $5K | 17.07% |
| VAN NOY INS. & FINANCIAL SVCS, INC.3 Filed as: VAN NOY INS. AND FINANCIAL SVCS INC | 7168 ARCHIBALD AVENUE, SUITE 280 ALTA LOMA, CA 91701 | AMERICAN HERITAGE LIFE INSURANCE | $830 | $0 | $830 | 3.02% |
| MARIA LOURDES MENDOZA3 Filed as: MARIA L. MENDOZA | 26443 SAND PALM COURT MORENO VALLEY, CA 92555 | AMERICAN HERITAGE LIFE INSURANCE | $203 | $0 | $203 | 0.74% |
| SALVADOR SANCHEZ3 | 10231 STANFORD AVENUE SOUTH GATE, CA 90280 | AMERICAN HERITAGE LIFE INSURANCE | $29 | $0 | $29 | 0.11% |
| ROGERS BENEFIT GROUP INC3 Filed as: STEPHEN W. ROGERS | 1207 NW 85TH TERRACE CORAL SPRINGS, FL 33071 | AMERICAN HERITAGE LIFE INSURANCE | $26 | $0 | $26 | 0.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 16030 VENTURA BOULEVARD, SUITE 500 ENCINO, CA 91436 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $760 | $2K | 16.88% |
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 | 94 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 96 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 74 | $785K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 94 | $66K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 94 | $66K |
| Life insurance(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE | 28 | $38K |
| Short-term disability | AMERICAN HERITAGE LIFE INSURANCE | 19 | $27K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 74 | $785K |
| Other(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE | 28 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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.