| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE | 700 AIRPORT BLVD., SUITE 300 BURLINGAME, CA 94010 | BLUE CROSS OF CALIFORNIA | $30K | — | $30K | 1.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY RISK PARTNERS | 456 MONTGOMERY STREET SAN FRANCISCO, CA 94104 | BLUE CROSS OF CALIFORNIA | $29K | — | $29K | 1.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY STREET PARTNERS | 456 MONTGOMERY STREET SAN FRANCISCO, CA 94104 | METROPOLITAN LIFE INSURANCE COMPANY | $16K | $1K | $18K | 8.40% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE | 160 FEDERAL STREET BOSTON, MA 02110 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | — | $9K | 4.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: EQUITY RISK PARTNERS | 456 MONTGOMERY STREET SAN FRANCISCO, CA 94104 | SAFEGUARD HEALTH PLANS, INC. | $2K | $143 | $2K | 8.55% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE | 2040 MAIN STREET IRVINE, CA 92614 | SAFEGUARD HEALTH PLANS, INC. | $821 | — | $821 | 4.01% |
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 | 218 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 218 | $1.7M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 620 | $229K |
| Vision | BLUE CROSS OF CALIFORNIA | 218 | $1.7M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 620 | $208K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 218 | $1.7M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 620 | $208K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 620 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.