| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SE | 4371 LATHAM STREET SUITE 101 RIVERSODE, CA 92501 | CALIFORNIA PHYSICIANS SERVICE | $64K | — | $64K | 4.19% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN INS AGENCY LLC | 9171 TOWNE CENTRE DRIVE SUITE 500 SAN DIEGO, CA 92122 | CALIFORNIA PHYSICIANS SERVICE | -$133 | — | -$133 | -0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | P.O. BOX 40 REDLANDS, CA 92373 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $206 | $3K | 21.18% |
| LUIS ERNESTO PEREZ3 | 861 KENWOOD STREET UPLAND, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $872 | $149 | $1K | 7.68% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $481 | $186 | $667 | 5.02% |
| GABRIEL HOLGUIN3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $514 | $95 | $609 | 4.58% |
| ADRIANA MENDIETA3 | 29448 TOURS STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $321 | $155 | $476 | 3.58% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $176 | $82 | $258 | 1.94% |
| NATIONAL VOLUNTARY BENEFITS INC3 | 12688 EAST DESERT COVE AVENUE SCOTTSDALE, AZ 85259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $95 | — | $95 | 0.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | C/O DICKERSON EMP BENEFITS LOS ANGELES, CA 90039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $93 | — | $93 | 0.70% |
| MARK MARQUEZ3 | 11225 NORTH 28TH DRIVE PHOENIX, AZ 85029 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $28 | $46 | 0.35% |
| PATRICIA FERNANDEZ3 | 1113 WEST MONTE CRISTO AVENUE PHOENIX, AZ 85023 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | — | $33 | 0.25% |
| SHERRI GUEDEA3 | 1101 CALIFORNIA AVENUE CORONA, CA 92881 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $32 | — | $32 | 0.24% |
| PRESTON ELDRIDGE DAVIS3 Filed as: PRESTON E DAVIS | 3642 WEST SCRIBNER LANE INGLEWOOD, CA 90305 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| FRANCES DARLENE PRINCE3 | 1101 CALIFORNIA AVENUE CORONA, CA 92881 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SE | 4371 LATHAM STREET SUITE 101 RIVERSIDE, CA 92501 | BLUESHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $465 | — | $465 | 4.69% |
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 | 263 | 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) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS SERVICE | 174 | $1.5M |
| Dental | CALIFORNIA PHYSICIANS SERVICE | 174 | $1.5M |
| Vision | CALIFORNIA PHYSICIANS SERVICE | 174 | $1.5M |
| Life insurance | BLUESHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | 216 | $10K |
| Prescription drug | CALIFORNIA PHYSICIANS SERVICE | 174 | $1.5M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 216 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.