| 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 | — | $45K | $45K | 6.39% |
| 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 | $3K | $13K | 14.98% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 2.36% |
| SABRINA AUGUST4 | 19011 TIGER TAIL ROAD GRASS VALLEY, CA 95949 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $124 | — | $124 | 5.79% |
| DEBRA OTTEN4 | 1808 KINGS LAKE BLVD. APT. 104 NAPLES, FL 34112 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $106 | — | $106 | 4.95% |
| TERRANCE J FITCH4 Filed as: TERRANCE J. FITCH | 9256 SVL BOX VICTORVILLE, CA 92395 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $72 | — | $72 | 3.36% |
| CHRISTA G AUFDEMBERG INC4 Filed as: CHRISTA G. AUFDEMBERG | 13102 BRITTANY WOODS DRIVE TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES INC. DBA LEGAL SHIELD | $46 | — | $46 | 2.15% |
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 | 122 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE | 126 | $700K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 123 | $87K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 123 | $87K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 123 | $87K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 123 | $87K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 126 | $700K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 123 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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.