| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 3.28% |
| COLONIAL LIFE & ACCIDENT3 | P.O. BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $145 | $4K | 16.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | SAFEGUARD HEALTH PLANS, INC. | $2K | — | $2K | 9.10% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | $43 | $2K | 11.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 7.09% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT | 1 S FAIR OAKS AVENUE PASADENA, CA 91105 | METROPOLITAN LIFE INSURANCE COMPANY | — | $22 | $22 | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | EYEMED VISION CARE | $952 | — | $952 | 10.78% |
| FLEXVISION - MD3 Filed as: FLEXVISION MD | 15400 CALHOUN DRIVE, SUITE 125 ROCKVILLE, MD 20855 | EYEMED VISION CARE | — | $174 | $174 | 1.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 12.81% |
| MARIA LOURDES MENDOZA3 Filed as: MARIA MENDOZA | 26443 SAND PALM COURT MORENO VALLEY, CA 92555 | ALLSTATE | $100 | — | $100 | 7.12% |
| WILLIAM J CAMPBELL3 Filed as: WILLIAM CAMPBELL | 2300 W. MANCHESTER BLVD. INGLEWOOD, CA 90305 | ALLSTATE | $51 | — | $51 | 3.63% |
| ROGERS BENEFIT GROUP INC3 Filed as: STEPHEN ROGERS | 1552 COLUMBINE WAY UPLAND, CA 91786 | ALLSTATE | $18 | — | $18 | 1.28% |
| GARY W JOHNSON3 Filed as: GARY JOHNSON | 6709 LA TIJERA BLVD. LOS ANGELES, CA 90045 | PRE-PAID LEGAL SERVICES, INC. | $29 | — | $29 | 4.92% |
| BRIAN SANDERSON3 | 1503 N. GRAND OAKS AVE. PASADENA, CA 91104 | PRE-PAID LEGAL SERVICES, INC. | $19 | — | $19 | 3.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | PRE-PAID LEGAL SERVICES, INC. | $8 | — | $8 | 1.36% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HEALTH NET | 67 | $560K |
| Dental(2 contracts, 2 carriers) | SAFEGUARD HEALTH PLANS, INC. | 106 | $35K |
| Vision | EYEMED VISION CARE | 106 | $9K |
| Life insurance(4 contracts, 3 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 127 | $58K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 15 | $39K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 127 | $9K |
| Prescription drug(2 contracts, 2 carriers) | HEALTH NET | 67 | $558K |
| Other(5 contracts, 4 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 127 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 127 | — |
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.