| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $90K | $13K | $104K | 5.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $801 | $9K | 16.41% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911023060 | EYEMED VISION CARE | $2K | — | $2K | 9.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $786 | — | $786 | 6.83% |
| MCCAREY INC3 Filed as: MCCAREY INC. | 965 MESA DRIVE CAMARILLO, CA 93010 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $310 | — | $310 | 2.69% |
| ANDREA MARIE TIERCE3 | 2204 PLEASANTWOOD LANE ESCONDIDO, CA 92026 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $123 | — | $123 | 1.07% |
| EDWIN MANUEL VELASQUEZ3 | 33013 SEVILLE STREET LAKE ELSINORE, CA 92530 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | — | $74 | 0.64% |
| DEBORAH LYNN WELLS3 | 5809 MARK TWAIN AVENUE SACRAMENTO, CA 95820 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 0.46% |
| DEL DOWNEY3 | 32056 MERLOT CREST TEMECULA, CA 92591 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.42% |
| BRIAN COHEN3 | 701 LEORA LANE THE COLONY, TX 75056 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30 | — | $30 | 0.26% |
| DONALD C SAVOY INC3 Filed as: DONALD TERRY GOTHAM | 3129 ECLIPSE DRIVE GREEN BAY, WI 54311 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $17 | — | $17 | 0.15% |
| ELTHON ISRAEL CRUZ3 | 3800 W. DEVONSHIRE AVENUE HEMET, CA 92545 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | — | $15 | 0.13% |
| SUSAN J LEACH3 Filed as: SUSAN J. LEACH | 4419 NE 131ST PLACE PORTLAND, OR 97230 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.12% |
| CALIFORNIA INSURANCE ADVOCATES INC3 Filed as: CALIFORNIA INSURANCE ADVOCATES INC. | 41960 AVENIDA DE ANITA TEMECULA, CA 92592 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.09% |
| R & B ENROLLMENT SERVICES INC3 Filed as: R & B ENROLLMENT SERVICES INC. | P.O. BOX 3216 CRESTLINE, CA 92325 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $114 | $1K | 16.57% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $292 | $292 | 3.99% |
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 | 470 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 472 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 221 | $1.9M |
| Dental | BLUE CROSS OF CALIFORNIA | 221 | $1.9M |
| Vision | EYEMED VISION CARE | 293 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 470 | $57K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 7 | $12K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 221 | $1.9M |
| Other(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 470 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 470 | — |
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.
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.