| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $29K | $0 | $29K | 3.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $23K | $0 | $23K | 3.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTRENATIONAL INS SERVICES INC | 40 EAST ALAMAR AVENUE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $20K | $2K | $22K | 16.52% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES R NELLIGAN & ASSOC LLC | 1933 STATE ROUTE 35, SUITE 368 WALL TOWNSHIP, NJ 07719 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $7K | $7K | 5.00% |
| UNKNOWN3 | UNKNOWN LONG BEACH, CA 90802 | LIBERTY DENTAL PLAN OF CALIFORNIA | $1K | $0 | $1K | 10.00% |
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 | 193 | 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) | 193 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 125 | $1.3M |
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $145K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $131K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $131K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $131K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 125 | $1.3M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 193 | $131K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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.