| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 4371 LATHAM STREET SUITE 101 RIVERSIDE, CA 92501 | BLUESHIELD OF CALIFORNIA | $61K | — | $61K | 3.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 470 EAST HIGHLAND AVENUE REDLANDS, CA 92373 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 7.68% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $375 | $175 | $550 | 2.72% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $369 | $41 | $410 | 2.03% |
| BENEFITS COORDINATOR3 | PO BOX 727 ARTESIA, CA 90702 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $259 | $61 | $320 | 1.58% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $234 | $49 | $283 | 1.40% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $187 | $30 | $217 | 1.07% |
| MARTHA R BAEZ3 | 2179 OLD BRIDGE ROAD RIVERSIDE, CA 92506 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $121 | $13 | $134 | 0.66% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $121 | $10 | $131 | 0.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS INC | C/O DICKERSON EMP BENEFITS LOS ANGELES, CA 90039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 0.35% |
| NATIONAL VOLUNTARY BENEFITS INC3 | 12688 EAST DESERT COVE AVENUE SCOTTSDALE, AZ 85259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.23% |
| MARQUEZ BENEFIT GROUP LLC3 | 11225 NORTH 28TH DRIVE PHOENIX, AZ 85029 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | $3 | $16 | 0.08% |
| PATRICIA FERNANDEZ3 | 1113 WEST MONTE CRISTO AVENUE PHOENIX, AZ 85023 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.07% |
| SHERRI GUEDEA3 | 1607 CHEROKEE ROAD CORONA, CA 92881 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 4371 LATHAM STREET SUITE 101 RIVERSODE, CA 92501 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $465 | — | $465 | 3.36% |
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 | 227 | 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) | 227 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUESHIELD OF CALIFORNIA | 151 | $1.5M |
| Dental | BLUESHIELD OF CALIFORNIA | 151 | $1.5M |
| Vision | BLUESHIELD OF CALIFORNIA | 151 | $1.5M |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 220 | $14K |
| Prescription drug | BLUESHIELD OF CALIFORNIA | 151 | $1.5M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 220 | $34K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.