| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | AETNA LIFE INSURANCE COMPANY | $134K | $0 | $134K | 4.59% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD TORRANCE, CA 90503 | AETNA HEALTH OF CALIFORNIA, INC. | $88K | $0 | $88K | 4.54% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $29K | $7K | $35K | 18.40% |
| FMLASOURCE INC5 Filed as: FMLASOURCE, INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $7K | $7K | 3.80% |
| PLANSOURCE BENEFITS ADMINISTRATION5 Filed as: PLANSOURCE BENEFIT ADMIN., INC. | PO BOX 1313 ORLANDO, FL 32802 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 2.60% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62949 VIRGINIA BEACH, VA 23466 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $5K | $0 | $5K | 10.83% |
| JOHNSON RESOURCES3 | 7373 EAST DOUBLETREE RANCH SUITE 200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 2.17% |
| USI INSURANCE SERVICES LLC3 | PO BOX 9004 VAN NUYS, CA 91409 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 11.00% |
| SULLIVANCURTISMONROE INS. SVCS.3 Filed as: SULLIVANCURTISMONROE INS SRVS, LLC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 7.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $146 | $0 | $146 | 0.74% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMIN., INC. | PO BOX 1313 ORLANDO, FL 32802 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $77 | $0 | $77 | 0.39% |
| USI INSURANCE SERVICES LLC3 | PO BOX 9004 VAN NUYS, CA 91409 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 16.20% |
| USI INSURANCE SERVICES LLC3 | 7535 IRVINE CENTER DRIVE, SUITE 250 IRVINE, CA 92618 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $524 | $0 | $524 | 3.37% |
| SULLIVANCURTISMONROE INS. SVCS.3 Filed as: SULLIVANCURTISMONROE INS SRVS, LLC | 1920 MAIN STREET, SUITE 600 IRVINE, CA 92614 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $436 | $0 | $436 | 2.80% |
| LONG TERM CARE SOLUTIONS, INC.3 | 14715 NW 95TH STREET, SUITE 200 REDMOND, WA 98052 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $323 | $0 | $323 | 2.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $58 | $0 | $58 | 0.37% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMIN., INC. | PO BOX 1313 ORLANDO, FL 32802 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $34 | $0 | $34 | 0.22% |
| STEVE BAKER4 | 153 ESTHER DRIVE COCOA BEACH, FL 32931 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $380 | $0 | $380 | 4.68% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES INC. DBA LEGALSHIELD | $23 | $0 | $23 | 0.28% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $109 | $0 | $109 | 2.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $104 | $0 | $104 | 2.05% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $44 | $0 | $44 | 0.87% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $44 | $0 | $44 | 0.87% |
| UZIEL RIVERA3 | 1267 SILVER TORCH DRIVE BEAUMONT, CA 92223 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $40 | $0 | $40 | 0.79% |
| DEL DOWNEY3 | 32056 MERLOT CREST TEMECULA, CA 92591 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $22 | $0 | $22 | 0.43% |
| SIMA BERNER REID3 Filed as: SIMA BERNER REID AND OTHER AGENTS | 10805 HOLDER STREET CYPRESS, CA 90630 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $15 | $0 | $15 | 0.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | FIRST UNUM LIFE INSURANCE COMPANY | $11 | $0 | $11 | 1.93% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFIT ADMIN., INC. | PO BOX 1313 ORLANDO, FL 32802 | FIRST UNUM LIFE INSURANCE COMPANY | $2 | $0 | $2 | 0.35% |
| MCCAREY INC3 Filed as: MCCAREY, INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 2.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 2.31% |
| DEL DOWNEY3 | 32056 MERLOT CREST TEMECULA, CA 92591 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.77% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.77% |
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 | 441 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 460 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 342 | $4.8M |
| Dental | AETNA LIFE INSURANCE COMPANY | 328 | $2.9M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 527 | $47K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 441 | $192K |
| Short-term disability(4 contracts, 4 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 50 | $26K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 441 | $192K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 342 | $4.8M |
| Other(5 contracts, 5 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 441 | $221K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 527 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.