| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | $0 | $11K | 0.76% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 0.26% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTIONS, INC. | 24 EAST SECOND STREET, 1ST FLOOR MEDIA, PA 19063 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $48K | $51K | $98K | 10.28% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $523 | $523 | 0.05% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTIONS, INC. | 24 EAST SECOND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST UNUM LIFE INSURANCE COMPANY | $118K | $12K | $130K | 22.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 Filed as: TRIBEN INSURANCE SOLUTIONS, INC. | 24 EAST SECOND STREET, 1ST FLOOR MEDIA, PA 19063 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $927 | $3K | 7.00% |
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 | 3,003 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 54 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,057 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 220 | $1.5M |
| Dental | DELTA DENTAL OF NEW YORK | 4,249 | $2.0M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 3,672 | $164K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,003 | $958K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 64 | $46K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 1,745 | $589K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 220 | $1.5M |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 6,966 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,966 | — |
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.