| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | HEALTH NET | $37K | $0 | $37K | 3.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SE | PO BOX 803 LOS ALAMOS, CA 93440 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $260 | $12K | 11.13% |
| DANA MARIE MOWATT3 | 23701 SOUTH WESTERN AVE SPC 112 TORRANCE, CA 90501 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $14K | $36 | $14K | 61.44% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $1K | $3K | 11.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 548 WEST CROMWELL AVENUE FRESNO, CA 93711 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 8.85% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNNARDINO, CA 92410 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $952 | $102 | $1K | 4.68% |
| BARRY W MAAS3 Filed as: BARRY W MAAS AND OTHER AGENTS | 1272 WEST MORAGA ROAD FRESNO, CA 93711 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $398 | $15 | $413 | 1.83% |
| TECH COORDINATOR CYBER INSURANCE SO3 Filed as: TECH COORDINATOR CYBER INS SO | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $387 | $0 | $387 | 1.72% |
| ANDREA MARIE TIERCE3 | 1199 MADRONE LANE PLACERVILLE, CA 95667 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $138 | $85 | $223 | 0.99% |
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 | 139 | 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) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 89 | $941K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 139 | $108K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 139 | $108K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 139 | $108K |
| Prescription drug | HEALTH NET | 89 | $941K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 139 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.