| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 3390 UNIVERSITY AVE., SUITE 300 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $27K | $3K | $30K | 4.15% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | BLUE CROSS OF CALIFORNIA | $9K | — | $9K | 1.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | P.O. BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | $447 | $13K | 4.21% |
| LEAVITT GROUP3 Filed as: LEAVITT INS. AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 1.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | P.O. BOX 2158 RIVERSIDE, CA 92501 | UNITED CONCORDIA INSURANCE COMPANY | $4K | $345 | $5K | 5.84% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | UNITED CONCORDIA INSURANCE COMPANY | $3K | — | $3K | 3.27% |
| LEAVITT GROUP3 Filed as: LEAVITT INS. AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | KAISER FOUNDATION HEALTH PLAN INC. | $1K | — | $1K | 5.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.41% |
| LEAVITT GROUP3 Filed as: LEAVITT GROUP AGENCY OF SAN DIEGO | 950 E. BLANCO ROAD SALINAS, CA 93901 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $372 | — | $372 | 2.39% |
| PACIFIC ADVISORS LLC3 | 333 INDIAN HILL BLVD. CLAREMONT, CA 91711 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7 | — | $7 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | P.O. BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $833 | $654 | $1K | 13.45% |
| LEAVITT GROUP3 Filed as: LEAVITT INS. AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $272 | — | $272 | 2.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | P.O. BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $594 | $448 | $1K | 13.15% |
| LEAVITT GROUP3 Filed as: LEAVITT INS. AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $198 | — | $198 | 2.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $401 | $150 | $551 | 15.34% |
| LEAVITT GROUP3 Filed as: LEAVITT INS. AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $139 | — | $139 | 3.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | P.O. BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $109 | $82 | $191 | 13.15% |
| LEAVITT GROUP3 Filed as: LEAVITT INS. AGENCY OF SAN DIEGO | 3636 NOBEL DRIVE, SUITE 100 SAN DIEGO, CA 92122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $36 | — | $36 | 2.48% |
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 | 108 | 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) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 72 | $1.1M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 99 | $82K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 83 | $16K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 108 | $8K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 10 | $4K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 108 | $11K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 72 | $1.1M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 108 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 108 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.