| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 6.45% |
| OMNIS RISK3 Filed as: OMNIS RISK INSURANCE SOLUTIONS, INC | 260 S SUNNYVALE, SUITE 4 SUNNYVALE, CA 94086 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 1.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | BLUE CROSS OF CALIFORNIA | $5K | $4K | $9K | 5.20% |
| OMNIS RISK3 Filed as: OMNIS RISK INSURANCE SOLUTIONS INC | 260 S SUNNYVALE AVE, #4 SUNNYVALE, CA 94086 | BLUE CROSS OF CALIFORNIA | $595 | — | $595 | 0.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | PREMIER ACCESS INSURANCE COMPANY | $2K | — | $2K | 3.36% |
| OMNIS RISK3 | 260 S SUNNYVALE AVENUE, #4 SUNNYVALE, CA 94086 | PREMIER ACCESS INSURANCE COMPANY | $501 | — | $501 | 0.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $718 | $3K | 16.83% |
| OMNIS RISK3 Filed as: OMNIS RISK INSURANCE SOLUTIONS, INC | 260 S SUNNYVALE AVENUE, #4 SUNNYVALE, CA 94086 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $595 | — | $595 | 3.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | EYEMED VISION CARE | $610 | — | $610 | 8.77% |
| OMNIS RISK3 | 260 S SUNNYVALE AVE SUNNYVALE, CA 94086 | EYEMED VISION CARE | $253 | — | $253 | 3.64% |
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 | 192 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 95 | $446K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 121 | $64K |
| Vision | EYEMED VISION CARE | 121 | $7K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $16K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $16K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 95 | $446K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 192 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.