| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN BOURLAND3 | 501 N EL CAMINO REAL STE 200 SAN CLEMENTE, CA 92672 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 6.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CAL INS SVS | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | -$218 | — | -$218 | -0.08% |
| SCAL INNOVATIVE SERVICES LLC3 Filed as: SCAL INNOVATIVE SERVICES | 122 AVENIDA DEL MAR STE G SAN CLEMENTE, CA 92672 | KAISER FOUNDATION HEALTH PLAN INC | $8K | — | $8K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CAL INS SVS | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $93 | — | $93 | 0.06% |
| SCAL INNOVATIVE SERVICES LLC3 Filed as: SCAL INNOVATIVE SERVICES | 122 AVENIDA DEL MAR STE G SAN CLEMENTE, CA 92672 | CIGNA LIFE AND HEALTH INSURANCE COMPANY | $15K | — | $15K | 10.71% |
| SCAL INNOVATIVE SERVICES LLC3 Filed as: SCAL INNOVATIVE SERVICES | 122 AVENIDA DEL MAR STE G SAN CLEMENTE, CA 92672 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| SCAL INNOVATIVE SERVICES LLC3 Filed as: SCAL INNOVATIVE SERVICES | 122 AVENIDA DEL MAR STE G SAN CLEMENTE, CA 92672 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| SCAL INNOVATIVE SERVICES LLC3 Filed as: SCAL INNOVATIVE SERVICES | 122 AVENIDA DEL MAR STE G SAN CLEMENTE, CA 92672 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $440 | — | $440 | 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 | 264 | 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) | 266 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 109 | $575K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $17K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $21K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 109 | $575K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 264 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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.