| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $78K | $457 | $78K | 5.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13K | — | $13K | 13.86% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $5K | $8K | 8.82% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $1K | $4K | 3.78% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $2K | $3K | 3.56% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $532 | $2K | 2.13% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $539 | $2K | 2.09% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $396 | $2K | 1.71% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $221 | $1K | 1.51% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER COURT MORENO VALLEY, CO 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $170 | $1K | 1.39% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DRIVE CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $533 | $128 | $661 | 0.69% |
| NATIONAL VOLUNTARY BENEFITS INC3 | 12688 EAST DESERT COVE AVENUE SCOTTSDALE, AZ 85259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $353 | — | $353 | 0.37% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | $72 | $175 | 0.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS, AN ALE | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | — | $64 | 0.07% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $50 | — | $50 | 0.05% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.01% |
| CONSUMER DRIVEN BENEFITS LLC3 | 3737 BIRCH STREET NEWPORT BEACH, CA 92660 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $4 | $9 | 0.01% |
| PATRICIA FERNANDEZ3 | 4949 NORTH 7TH STREET PHOENIX, AZ 85014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.01% |
| TINA HERNANDEZ3 | 11779 WEST COCOPAH STREET AVONDALE, AZ 85323 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.01% |
| SHERRI GUEDEA3 | 1607 CHEROKEE ROAD CORONA, CA 92881 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $21 | $5K | 6.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 2.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | — | $935 | $935 | 1.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | — | $7K | 15.10% |
| JOHN D EVANGELISTA3 | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $3K | $4K | 10.10% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $823 | $2K | 4.28% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $706 | $1K | $2K | 3.93% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $385 | $1K | 3.14% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $157 | $1K | 2.70% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $638 | $215 | $853 | 1.92% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $665 | $133 | $798 | 1.80% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $358 | $129 | $487 | 1.10% |
| NATIONAL VOLUNTARY BENEFITS INC3 | 12688 EAST DESERT COVE AVENUE SCOTTSDALE, AZ 85259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $177 | — | $177 | 0.40% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | $41 | $94 | 0.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS, AN ALE | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $28 | — | $28 | 0.06% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.06% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.03% |
| SHERRI GUEDEA3 | 1607 CHEROKEE ROAD CORONA, CA 92881 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.02% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DRIVE CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $1 | $6 | 0.01% |
| PATRICIA FERNANDEZ3 | 4949 NORTH 7TH STREET PHOENIX, AZ 85014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6 | — | $6 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $2K | — | $2K | 10.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $519 | $519 | 2.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $289 | $289 | 1.60% |
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 | 177 | 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) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 232 | $1.5M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 337 | $90K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 337 | $72K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 337 | $72K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 337 | $212K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 337 | — |
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.