| 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 | $44K | $2 | $44K | 2.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24K | — | $24K | 14.57% |
| JOHN D EVANGELISTA3 | 186 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $2K | $8K | 4.78% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $558 | $6K | 3.78% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $1K | $6K | 3.40% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $888 | $5K | 2.76% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $923 | $4K | 2.26% |
| LUIS RAFAEL VALLE3 | 2354 CHATKA LANE SAN BERNARDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $874 | $132 | $1K | 0.61% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $801 | $123 | $924 | 0.56% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA STREET SAN DIEGO, CA 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $264 | $2 | $266 | 0.16% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DRIVE CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $213 | $27 | $240 | 0.15% |
| NATIONAL VOLUNTARY BENEFITS INC3 | 12688 EAST DESERT COVE AVENUE SCOTTSDALE, AZ 85259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $237 | — | $237 | 0.14% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $172 | — | $172 | 0.10% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $59 | $21 | $80 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS, AN ALE | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.03% |
| CHAU PHAN3 | 6 FOREST IRVINE, CA 92612 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | — | $34 | 0.02% |
| CORNER BEAR INC3 | 15904 KENNARD STREET HACIENDA HEIGHTS, CA 91745 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $27 | — | $27 | 0.02% |
| ELTHON ISRAEL CRUZ3 | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.01% |
| PATRICIA FERNANDEZ3 | 4534 EAST DEVONSHIRE AVENUE PHOENIX, AZ 85018 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 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 | $6K | $944 | $7K | 6.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | — | $2K | $2K | 2.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 10.48% |
| JOHN D EVANGELISTA3 | 151 LAS FLORES ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $538 | $2K | 4.09% |
| TECH COORDINATOR CYBER INSURANCE SO3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $229 | $1K | 2.44% |
| SARAH COURTNEY KNAPP3 | 61 SKLAR LADERA RANCH, CA 92694 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $946 | $289 | $1K | 2.34% |
| LUIS ERNESTO PEREZ3 Filed as: LUIS PEREZ BENEFIT INSURANCE SOLUTI | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $976 | $220 | $1K | 2.27% |
| MARIA C GONZALEZ3 | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $704 | $54 | $758 | 1.44% |
| LUIS RAFAEL VALLE3 Filed as: LUIS RAFAEL VALLEY | 2354 CHATKA LANE SAN BERNANDINO, CA 92410 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $385 | $58 | $443 | 0.84% |
| GOLD RIVER FINANCIAL GROUP LLC3 | 2807 GRATTON STREET RIVERSIDE, CA 92504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $118 | $4 | $122 | 0.23% |
| NATIONAL VOLUNTARY BENEFITS INC3 | 12688 EAST DESERT COVE AVENUE SCOTTSDALE, AZ 85259 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $77 | — | $77 | 0.15% |
| RAYMOND KWOCKMAN GONG3 | 1907 COLUMBIA STREET SAN DIEGO, CO 92101 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $46 | — | $46 | 0.09% |
| ELTHON ISRAEL CRUZ3 Filed as: ELTHON ISREAEL CRUZ | 893 SOUTH 2100 WEST OREN, UT 84059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $43 | — | $43 | 0.08% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | — | $35 | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS, AN ALE | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 0.05% |
| MARQUEZ BENEFIT GROUP LLC3 | 8601 NORTH BLACK CANYON HIGHWAY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $1 | $17 | 0.03% |
| ERIC ALEXANDER NOVOA3 | 17871 SHADY VIEW DRIVE CHINO HILLS, CA 91709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.02% |
| SHERRI GUEDEA3 | 1607 CHEROKEE ROAD CORONA, CA 92881 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| PATRICIA FERNANDEZ3 | 5455 NORTH 18TH STREET PHOENIX, AZ 85016 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 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 CORPORTION | $1K | — | $1K | 10.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORTION | — | $476 | $476 | 3.46% |
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 | 170 | 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) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 234 | $1.7M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 358 | $116K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 358 | $102K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 358 | $102K |
| Other(3 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 358 | $319K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 358 | — |
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.