| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMA, INC.3 | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN, INC. | $17K | $11 | $17K | 3.46% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | KAISER FOUNDATION HEALTH PLAN, INC. | $12K | — | $12K | 2.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | DELTA DENTAL OF CALIFORNIA | $7K | — | $7K | 5.82% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 4.15% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $437 | $3K | 11.90% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $408 | $3K | 11.81% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $341 | $2K | 11.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $730 | — | $730 | 5.49% |
| MICHAEL HAND3 | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $716 | — | $716 | 5.38% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $855 | $168 | $1K | 11.97% |
| MICHAEL HAND3 Filed as: MICHAEL DENNIS HAND | 100 CORPORATE POINTE SUITE 210 CULVER CITY, CA 90230 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $657 | $130 | $787 | 11.98% |
| D'ANN DABELL4 | 1174 N. 2000 EAST LAYTON, UT 840402337 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $475 | — | $475 | 8.62% |
| DON R. WILSON4 | 146 RAINBOW DRIVE PMB 4679 LIVINGSTON, TX 773991046 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $446 | — | $446 | 8.10% |
| ROCK WACH4 | 1396 N. MORTON DRIVE SALT LAKE CITY, UT 841161465 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $21 | — | $21 | 0.38% |
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 | 143 | 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) | 143 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 82 | $496K |
| Dental | DELTA DENTAL OF CALIFORNIA | 224 | $119K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 200 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $30K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 40 | $23K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 48 | $18K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 82 | $487K |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 143 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.