| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $38K | $399 | $38K | 4.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $9K | $1K | $10K | 11.01% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS. AGCY. & FIN. SVCS. | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $3K | $3K | 3.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | 3635 RIVERSIDE PLAZA DRIVE BUILDING M3, SUITE 320 RIVERSIDE, CA 92506 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $832 | $458 | $1K | 23.26% |
| BENEFITMALL3 | 6200 CANOGA AVENUE, SUITE 300 WOODLAND HILLS, CA 91367 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $91 | $0 | $91 | 1.64% |
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 | 173 | 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) | 173 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 118 | $874K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 159 | $91K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 159 | $91K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 173 | $6K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 173 | $6K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 118 | $874K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 173 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.