| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $3K | — | $3K | 0.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA FUND ADMINISTRATORS, LLC EIN 45-2636626 NONE | Direct payment from the plan; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $296K |
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $104K |
| KRAW LAW GROUP EIN 32-0465891 NONE | Legal Service code 29 | — | $58K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $50K |
| HUB INTERNATIONAL EIN 33-0315047 NONE | Consulting (general) Service code 16 | — | $40K |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 NONE | Insurance services; Claims processing Service code 12 | — | $34K |
| UNITED ADMINISTRATIVE SERVICES EIN 94-1749354 NONE | Accounting (including auditing); Contract Administrator Service code 10 | — | $21K |
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 | 668 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 173 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 841 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,003 | $4.7M |
| Dental | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 340 | $59K |
| Vision | VISION SERVICE PLAN | 678 | $99K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 719 | $35K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 488 | $424K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 719 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,003 | — |
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.