| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN, INC. | $25K | $0 | $25K | 3.68% |
| ACCESSEHR INSURANCE SERVICES3 Filed as: ACCESSEHR INSURANCE SERVICES INC | 2300 CONTRA COSTA BOULEVARD SUITE 520 PLEASANT HILL, CA 94523 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | $0 | $8K | 1.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | UNITEDHEALTHCARE INSURANCE COMPANY | $6K | $0 | $6K | 4.49% |
| ACCESSEHR INSURANCE SERVICES3 Filed as: ACCESSEHR INSURANCE SERVICES INC | 2300 CONTRA COSTA BOULEVARD SUITE 520 PLEASANT HILL, CA 94523 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | $0 | $2K | 1.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | UNKNOWN WALNUT CREEK, CA 94598 | DELTA DENTAL | $4K | $0 | $4K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL SERVICES | 1999 HARRISON STREET, SUITE 650 OAKLAND, CA 94612 | HARTFORD LIFE AND ACCIDENT | $3K | $0 | $3K | 7.81% |
| ACCESSEHR INSURANCE SERVICES3 Filed as: ACCESSEHR INSURANCE SERVICES INC | 2300 CONTRA COSTA BOULEVARD PLEASANT HILL, CA 94523 | HARTFORD LIFE AND ACCIDENT | $2K | $0 | $2K | 5.99% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BOULEVARD, SUITE 200 HAUPPAUGE, NY 11788 | HARTFORD LIFE AND ACCIDENT | $0 | $913 | $913 | 2.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 970 RESERVE DRIVE ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | $0 | $415 | $415 | 1.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $654 | $0 | $654 | 5.46% |
| ACCESSEHR INSURANCE SERVICES3 Filed as: ACCESSEHR INSURANCE SERVICES INC | 2300 CONTRA COSTA BOULEVARD SUITE 520 PLEASANT HILL, CA 94523 | VISION SERVICE PLAN | $279 | $0 | $279 | 2.33% |
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 | 120 | 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) | 120 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 78 | $813K |
| Dental | DELTA DENTAL | 63 | $40K |
| Vision | VISION SERVICE PLAN | 94 | $12K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 106 | $35K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 106 | $35K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 78 | $813K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 120 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 120 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.