| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JEFFREY R. SLAY3 | PO BOX 8360 GOLETA, CA 93118 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 7.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $234 | $4K | 4.08% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 9171 TOWNE CENTRE, SUITE 500 SAN DIEGO, CA 92122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $298 | — | $298 | 0.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | EYEMED VISION CARE | $7K | — | $7K | 17.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.84% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 9171 TOWNE CENTRE, SUITE 500 SAN DIEGO, CA 92122 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $325 | — | $325 | 0.90% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $59 | $59 | 0.16% |
| JESSE RAMOS4 | 7331 SHELBY LANE, SUITE 26 RANCHO CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $733 | — | $733 | 10.41% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON AND COMPANY | 3475 EAST FOOTHILL BOULEVARD PASADENA, CA 91107 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $384 | — | $384 | 5.45% |
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 | 483 | 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) | 483 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 301 | $960K |
| Dental | DELTA DENTAL OF CALIFORNIA | 868 | $366K |
| Vision | EYEMED VISION CARE | 651 | $39K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 483 | $105K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 483 | $105K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 301 | $960K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 483 | $148K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 868 | — |
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.