| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| Q.S.R. INSURANCE AGENCY, INC.3 Filed as: Q.S.R. INSURANCE AGENCY | 18607 VENTURA BLVD TARZANA, CA 91356 | AETNA LIFE INSURANCE COMPANY | $7K | — | $7K | 10.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | AETNA LIFE INSURANCE COMPANY | $812 | $3K | $4K | 5.79% |
| Q.S.R. INSURANCE AGENCY, INC.3 Filed as: Q.S.R. INSURANCE AGENCY | PO BOX 570245 TARZANA, CA 91357 | VISION SERVICE PLAN | $761 | — | $761 | 5.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | VISION SERVICE PLAN | $69 | — | $69 | 0.50% |
| Q.S.R. INSURANCE AGENCY, INC.3 Filed as: Q.S.R. INSURANCE AGENCY | 18607 VENTURA BLVD TARZANA, CA 91356 | GUARDIAN | $383 | — | $383 | 10.01% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE COMPANY | 238 | $64K |
| Vision | VISION SERVICE PLAN | 113 | $14K |
| Life insurance | GUARDIAN | 127 | $4K |
| Other | GUARDIAN | 127 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 238 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.