| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS | 4371 LATHAM STREET RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC. | $85K | — | $85K | 2.99% |
| BENEFITS EXCHANCE ALLIANCE3 | 23716 BIRTHCER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC. | $16K | — | $16K | 0.54% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS | P.O. BOX 2158 RIVERSIDE, CA 92516 | BLUE CROSS OF CALIFORNIA | $37K | $2K | $39K | 2.79% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 0.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 4371 LATHAM STREET RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 0.08% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | SIMNSA | $5K | — | $5K | 5.00% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS | 820 GRESSNER ROAD HOUSTON, TX 77024 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 11.05% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 1.63% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS | P.O BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $1K | — | $1K | 2.01% |
| BENEFITS EXCHANGE ALLIANCE3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | VISION SERVICE PLAN | $803 | — | $803 | 1.33% |
| COLONIAL LIFE & ACCIDENT3 | P.O BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16K | $4K | $20K | 33.74% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS | 3635 RIVERSIDE PLAZA DRIVE RIVERSIDE, CA 92506 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 13.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2158 RIVERSIDE, CA 92516 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $779 | $779 | 1.84% |
| COLONIAL LIFE & ACCIDENT3 | P.O. BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $267 | $1K | 58.94% |
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 | 816 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 818 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 662 | $4.4M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 816 | $92K |
| Vision | VISION SERVICE PLAN | 762 | $60K |
| Life insurance(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 263 | $1.5M |
| Short-term disability(2 contracts) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 73 | $61K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 662 | $4.4M |
| Other(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 263 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 816 | — |
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."
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.