| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | PO BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $28K | $663 | $29K | 4.86% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE ADMIN INC. | 721 S PARKER ST STE 300 ORANGE, CA 928684732 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 1.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPAY | 3475 E FOOTHILL BLVD SUITE 100 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $23K | $1K | $24K | 8.05% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: WORD & BROWN INSURANCE ADMIN INC | 721 S PARKER STREET ORANGE, CA 92868 | BLUE CROSS OF CALIFORNIA | — | $11K | $11K | 3.51% |
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 | 160 | 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) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 934 | $889K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $84K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $84K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 0 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 934 | — |
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.