| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | — | $43K | $43K | 6.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | $2K | $11K | 13.78% |
| SABRINA AUGUST4 | 19011 TIGER TAIL ROAD GRASS VALLEY, CA 95949 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $93 | — | $93 | 5.08% |
| DEBRA OTTEN4 | 1808 KINGS LAKE BLVD. APT. 104 NAPLES, FL 34112 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $81 | — | $81 | 4.42% |
| ZACH J. FITHC4 | 6965 SVL BOX VICTORVILLE, CA 92395 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $44 | — | $44 | 2.40% |
| LIZ BAILEY4 | 1624 H STREET RAMONA, CA 92065 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $28 | — | $28 | 1.53% |
| TERRANCE J FITCH4 Filed as: TERRANCE J. FITCH | 6965 SVL BOX VICTORVILLE, CA 92395 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $20 | — | $20 | 1.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | EYEMED VISION CARE | $159 | — | $159 | 29.89% |
| JOHNSON RESOURCES3 | 7373 E. DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | — | $32 | $32 | 6.02% |
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 | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 108 | $636K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 107 | $82K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 108 | $636K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 107 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 108 | — |
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.