| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TERRY L. IAVICOLI3 | 220 RUTH ANN WAY ARROYO GRANDE, CA 93420 | AFLAC | $14K | $588 | $15K | 13.43% |
| EARNESTO GONZALEZ INS. SVCS. CORP.3 | 1618 SANTILLAN AVENUE SANTA MARIA, CA 93458 | AFLAC | $2K | $117 | $2K | 1.75% |
| JOSH MITTMANN3 | 741 LEMOORE STREET PISMO BEACH, CA 93449 | AFLAC | $2K | — | $2K | 1.49% |
| MJ INSURANCE3 Filed as: SCOTT BLACKSHEAR AND VARIOUS AGENTS | 3453 CATHRYN DRIVE COLUMBUS, GA 31906 | AFLAC | $1K | $117 | $2K | 1.42% |
| DANIEL COLE3 | 5558 CALIFORNIA AVENUE, SUITE 320 BAKERSFIELD, CA 93309 | AFLAC | $982 | $117 | $1K | 1.01% |
| MICHAEL W. ATTERBERRY3 Filed as: MICHAEL LIZALDE | 1955 MINDA DRIVE EUGENE, OR 97401 | AFLAC | $441 | — | $441 | 0.40% |
| KIRK LINDSEY3 | 4465 NOTTINGHAM DRIVE SANTA MARIA, CA 93455 | AFLAC | $376 | — | $376 | 0.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 3.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2560 PROFESSIONAL PARKWAY SANTA MARIA, CA 93455 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $550 | $550 | 0.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 844663 DALLAS, TX 75284 | VISION SERVICE PLAN | $916 | — | $916 | 6.24% |
| TERRY L. IAVICOLI3 Filed as: TERRY IAVICOLI | 220 RUTH ANN WAY ARROYO GRANDE, CA 93420 | AFLAC | $1K | $32 | $1K | 12.38% |
| JOSH MITTMANN3 | 741 LEMOORE STREET PISMO BEACH, CA 93449 | AFLAC | $167 | $133 | $300 | 3.14% |
| MJ INSURANCE3 Filed as: SCOTT BLACKSHEAR AND VARIOUS AGENTS | 3453 CATHRYN DRIVE COLUMBUS, GA 31906 | AFLAC | $145 | — | $145 | 1.52% |
| ERNESTO GONZALEZ INS. SVCS., CORP.3 Filed as: ERNESTO GONZALEZ INS. SVCS. CORP. | 1618 SANTILLAN AVENUE SANTA MARIA, CA 93458 | AFLAC | $142 | — | $142 | 1.49% |
| DANIEL COLE3 | 5558 CALIFORNIA AVENUE, SUITE 320 BAKERSFIELD, CA 93309 | AFLAC | $71 | — | $71 | 0.74% |
| MICHAEL W. ATTERBERRY3 Filed as: MICHAEL LIZALDE | 1955 MINDA DRIVE EUGENE, OR 97401 | AFLAC | $37 | — | $37 | 0.39% |
| KIRK LINDSEY3 | 4465 NOTTINGHAM DRIVE SANTA MARIA, CA 93455 | AFLAC | $31 | — | $31 | 0.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92501 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $538 | $268 | $806 | 14.98% |
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 | 116 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | AFLAC | 92 | $119K |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 100 | $98K |
| Vision | VISION SERVICE PLAN | 70 | $15K |
| Life insurance(3 contracts, 2 carriers) | AFLAC | 116 | $124K |
| Other(3 contracts, 2 carriers) | AFLAC | 116 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.