| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 8777 N GAINEY CENTER DR STE 100 STE 700 SCOTTSDALE, AZ 852532120 | KAISER FOUNDATION HEALTH PLAN, INC. | $9K | — | $9K | 3.34% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | PO BOX 3430 CARMEL, IN 46082 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | — | $6K | 2.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $4K | $10K | 8.61% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 5.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $934 | $2K | 10.13% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 7.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $882 | $746 | $2K | 8.82% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $965 | — | $965 | 5.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $446 | $624 | $1K | 5.99% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $823 | — | $823 | 4.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $861 | $660 | $2K | 12.27% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $998 | — | $998 | 8.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $557 | $510 | $1K | 8.70% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $668 | — | $668 | 5.45% |
| THE ULTIMATE SOFTWARE GROUP5 | 2000 ULTIMATE WAY WESTON, FL 33326 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 38.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $568 | $319 | $887 | 11.38% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $601 | — | $601 | 7.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | CONCERN EAP | $232 | — | $232 | 3.74% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | PO BOX 3430 CARMEL, IN 46082 | CONCERN EAP | $78 | — | $78 | 1.26% |
| THE ULTIMATE SOFTWARE GROUP5 | 2000 ULTIMATE WAY WESTON, FL 33326 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 87.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 6720 N. SCOTTSDALE ROAD, SUITE 310 SCOTTSDALE, AZ 85253 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $231 | $272 | $503 | 14.70% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | 571 MONON BLVD STE 400 CARMEL, IN 46032 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $282 | — | $282 | 8.24% |
| MJ INSURANCE3 Filed as: MJ INSURANCE INC | PO BOX 3430 CARMEL, IN 46082 | BLUE CROSS OF CALIFORNIA | -$6K | — | -$6K | — |
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 | 171 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 174 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 42 | $263K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 152 | $111K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $18K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 171 | $31K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 49 | $12K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 45 | $22K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 42 | $263K |
| Other(6 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 185 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 185 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.