| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KTIMEHR INSURANCE SERVICES INC.3 | 17872 COWAN IRVINE, CA 92614 | BLUE CROSS OF CALIFORNIA | $75K | — | $75K | 2.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | BLUE CROSS OF CALIFORNIA | $50K | — | $50K | 1.65% |
| KTIMEHR INSURANCE SERVICES INC.3 | 17872 COWAN IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC. | $31K | — | $31K | 1.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $20K | $4K | $25K | 1.17% |
| KTIMEHR INSURANCE SERVICES INC.3 | 17872 COWAN IRVINE, CA 92614 | METROPOLITAN LIFE INSURANCE COMPANY | $36K | — | $36K | 6.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | METROPOLITAN LIFE INSURANCE COMPANY | $24K | $55 | $24K | 4.02% |
| KTIMEHR INSURANCE SERVICES INC.3 | 17872 COWAN IRVINE, CA 92614 | KAISER FOUNDATION HEALTH PLAN INC. | $8K | — | $8K | 1.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | $1K | $6K | 1.15% |
| KTIMEHR INSURANCE SERVICES INC.3 | 17872 COWAN IRVINE, CA 92614 | VISION SERVICE PLAN | $2K | — | $2K | 1.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | VISION SERVICE PLAN | $1K | — | $1K | 1.20% |
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 | 521 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 528 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 455 | $5.7M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 959 | $603K |
| Vision | VISION SERVICE PLAN | 569 | $90K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 959 | $603K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 959 | $603K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 959 | $603K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 455 | $5.7M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 959 | $603K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 959 | — |
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.