| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BAYSIDE INSURANCE MARKETING, INC.3 Filed as: BAYSIDE INSURANCE MARKETING INC | UNKNOWN MOUNTAIN VIEW, CA 94041 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $22K | $0 | $22K | 7.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERV INC | UNKNOWN MOUNTAIN VIEW, CA 94041 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | $0 | $13K | 4.20% |
| BAYSIDE INSURANCE MARKETING, INC.3 Filed as: BAYSIDE INSURANCE MARKETING INC | PO BOX 51596 PALO ALTO, CA 94303 | KAISER FOUNDATION HEALTH PLAN INC | $6K | $0 | $6K | 2.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERV INC | PO BOX 4047 CONCORD, CA 94524 | KAISER FOUNDATION HEALTH PLAN INC | $3K | $0 | $3K | 1.24% |
| BAYSIDE INSURANCE MARKETING, INC.3 Filed as: BAYSIDE INSURANCE MARKETING INC | PO BOX 51596 PALO ALTO, CA 94303 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $3K | $0 | $3K | 2.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERV INC | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $2K | $0 | $2K | 2.06% |
| BAYSIDE INSURANCE MARKETING, INC.3 Filed as: BAYSIDE INSURANCE MARKETING INC | PO BOX 51596 PALO ALTO, CA 94303 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $0 | $4K | 6.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERV INC | 580 CALIFORNIA STREET SUITE 1300 SAN FRANCISCO, CA 94104 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $45 | $2K | 3.53% |
| BEERE & PURVES INC3 Filed as: BEERE AND PURVES, INC | 500 YGNACIO VALLEY ROAD SUITE 450 WALNUT CREEK, CA 94596 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERV INC | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $764 | $0 | $764 | 3.06% |
| BAYSIDE INSURANCE MARKETING, INC.3 Filed as: BAYSIDE INSURANCE MARKETING INC | PO BOX 51596 PALO ALTO, CA 94303 | VISION SERVICE PLAN | $494 | $0 | $494 | 1.98% |
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 | 112 | 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) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 111 | $551K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 104 | $107K |
| Vision | VISION SERVICE PLAN | 106 | $25K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 112 | $54K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 112 | $54K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 112 | $54K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 112 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 112 | — |
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.