| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFITS AMERICA INS. SVCS., LLC3 | 1800 QUAIL STREET, SUITE 110 NEWPORT BEACH, CA 92660 | CALIFORNIA PHYSICIANS SERVICE | $0 | $45K | $45K | 3.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 195TH STREET, SUITE 200 BOTHELL, WA 98011 | CALIFORNIA PHYSICIANS SERVICE | $0 | $29K | $29K | 2.06% |
| THE LIBERTY COMPANY INSURANCE3 | UNKNOWN SAN FRANCISCO, CA 94080 | DELTA DENTAL OF CALIFORNIA | $15K | $0 | $15K | 8.24% |
| LIBERTY COMPANY INSURANCE BROKERS3 Filed as: THE LIBERTY COMPANY INS BROKERS INC | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $0 | $11K | 10.30% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $2K | $7K | 6.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $177 | $5K | 4.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 749083 LOS ANGELES, CA 90074 | KAISER FOUNDATION HEALTH PLAN, INC | $3K | $0 | $3K | 5.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 749083 LOS ANGELES, CA 90074 | KAISER FOUNDATION HEALTH PLAN, INC | $265 | $0 | $265 | 4.55% |
| LIBERTY COMPANY INSURANCE BROKERS3 Filed as: THE LIBERTY INSURANCE BROKERS | 5955 DE SOTO AVENUE, SUITE 250 WOODLAND HILLS, CA 91367 | KAISER FOUNDATION HEALTH PLAN, INC | -$264 | $0 | -$264 | -4.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 3018 BOTHELL, WA 98041 | METLIFE LEGAL PLANS | $97 | $0 | $97 | 9.82% |
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 | 244 | 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) | 244 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 263 | $1.5M |
| Dental | DELTA DENTAL OF CALIFORNIA | 335 | $180K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 244 | $108K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 244 | $108K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 244 | $108K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 244 | $108K |
| Prescription drug(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 263 | $1.5M |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 244 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 335 | — |
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.