| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | BLUE CROSS OF CALIFORNIA | $56K | $3K | $59K | 5.64% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | BLUE CROSS OF CALIFORNIA | $0 | $22K | $22K | 2.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 40 EAST ALAMAR AVENUE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $20K | $9K | $29K | 14.14% |
| FMLASOURCE INC5 | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $3K | $3K | 1.32% |
| TERRY L. IAVICOLI3 | 220 RUTH ANN WAY ARROYO GRANDE, CA 93420 | AFLAC | $1K | $0 | $1K | 5.96% |
| SCOTT W BLACKSHEAR AND OTHER AGENTS3 | 108 ALSACE COURT PONTE VEDRA BEACH, FL 32082 | AFLAC | $329 | $0 | $329 | 1.53% |
| DAWN T SUCHECKI3 Filed as: DAWN M. TYACK | 582 CAMINO MERCADO ARROYO GRANDE, CA 93420 | AFLAC | $194 | $0 | $194 | 0.90% |
| MICHAEL W. ATTERBERRY3 Filed as: MICHAEL JOHN LIZALDE | 1955 MINDA DRIVE EUGENE, OR 97401 | AFLAC | $184 | $0 | $184 | 0.86% |
| KAREN LEE LINDSEY3 | 4465 NOTTINGHAM DRIVE SANTA MARIA, CA 93455 | AFLAC | $144 | $0 | $144 | 0.67% |
| DANIEL VORDALE INS SVCS INC3 Filed as: DANIEL VORDALE | 705 SAINT ANDREWS WAY LOMPOC, CA 93436 | AFLAC | $89 | $0 | $89 | 0.41% |
| KARL J. SHAFER3 | 605 ISLAND VIEW CIRCLE PORT HUENEME, CA 93041 | AFLAC | $69 | $0 | $69 | 0.32% |
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 | 129 | 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) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 191 | $1.0M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $204K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $204K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $204K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $204K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $204K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 129 | $226K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.