| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERGRATED INSURANCE SERVICES3 | PO BOX 609 SANTA BARBARA, CA 93102 | CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES | $5K | — | $5K | 1.25% |
| NEOVIA INTEGRATED INSURANCE SVCS.3 Filed as: NEOVIA INTERGRATED INSURANCE SVCS. | PO BOX 609 SANTA BARBARA, CA 93102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $8K | — | $8K | 8.60% |
| NEOVIA INTEGRATED INSURANCE SVCS.3 Filed as: NEOVIA INTERGRATED INSURANCE SVCS. | PO BOX 8360 GOLETA, CA 93118 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 1.41% |
| INTERGRATED INSURANCE SERVICES3 | PO BOX 609 SANTA BARBARA, CA 93102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $972 | — | $972 | 3.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $925 | — | $925 | 3.03% |
| 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 | $196 | — | $196 | 0.64% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $37 | $37 | 0.12% |
| JESSE RAMOS4 | 7331 SHELBY LANE, SUITE 26 RANCHO CUCAMONGA, CA 91739 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $1K | — | $1K | 13.56% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $313 | — | $313 | 3.31% |
| DERRICK T. WILLIAMS4 | 3990 INLAND EMPIRE BOULEVARD ONTARIO, CA 91764 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $29 | — | $29 | 0.31% |
| 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 | $117 | — | $117 | 3.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $76 | $2 | $78 | 2.02% |
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 | 438 | 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) | 438 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 266 | $900K |
| Dental | CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES | 438 | $377K |
| Vision | CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES | 438 | $377K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 438 | $88K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 150 | $31K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 438 | $88K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 266 | $900K |
| Other(4 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 438 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 438 | — |
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.