| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALGENTIS INSURANCE SERVICES, LLC3 Filed as: ALGENTIS INSURANCESERVICES, INC. | PO BOX 2158 RIVERSIDE, CA 92516 | BLUE CROSS OF CALIFORNIA | $82K | — | $82K | 3.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE,SUITE 300 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $13K | $13K | 0.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | BLUE CROSS OF CALIFORNIA | $9K | — | $9K | 0.39% |
| ALGENTIS, LLC3 | 333 WEST EL CAMINO REAL, SUITE 330 SUNNYVALE, CA 94087 | KAISER FOUNDATION HEALTH PLAN INC. | $20K | — | $20K | 5.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 4047 CONCORD, CA 94524 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 0.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | — | $576 | $576 | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 333 WEST EL CAMINO REAL SUNNYVALE, CA 94087 | DELTA DENTAL OF CALIFORNIA | $22K | — | $22K | 7.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 0.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 333 WEST EL CAMINO REAL SUNNYVALE, CA 94087 | VISION SERVICE PLAN | $22K | — | $22K | 7.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $2K | — | $2K | 0.75% |
| ALGENTIS, LLC3 | 201 NORTH CIVIS DRIVE, SUITE 100 WALNUT CREEK, CA 94596 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | $894 | $7K | 8.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $482 | — | $482 | 0.54% |
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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 95 | $2.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 196 | $298K |
| Vision | VISION SERVICE PLAN | 196 | $298K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 192 | $90K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 192 | $90K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 95 | $2.7M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 192 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.