| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INT. OF CA INSURANCE SERVICES | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 1.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INT. INSURANCE SERVICES INC | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | — | $4K | 1.21% |
| CHUN-HA INSURANCE SERVICES, INC.3 Filed as: CHUN HA INSURANCE SERVICES, INC. | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 928441309 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | — | $2K | 0.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 2.00% |
| GOOD FRIEND INSURANCE SERVICES LLC3 Filed as: GOOD FRIEND INSURANCE SERVICES, LLC | 3580 WILSHIRE BLVD SUITE 1510 LOS ANGELES, CA 90010 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 13.51% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES LLC | 2677 N MAIN STREET SANTA ANA, CA 92705 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $0 | $1K | $1K | 2.70% |
| GOOD FRIEND INSURANCE SERVICES LLC3 Filed as: GOOD FRIEND INSURANCE SERVICES, LLC | 3580 WILSHIRE BLVD #1510 LOS ANGELES, CA 90010 | EYEMED VISION CARE | $4K | — | $4K | 10.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 14.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 16.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $931 | — | $931 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 17.59% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 9122 GARDEN GROVE BLVD GARDEN GROVE, CA 92844 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $676 | — | $676 | 9.99% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: HUB INTERNATIONAL INS SVCS INC | — | CIGNA | $90K | — | $90K | — |
| CHUN-HA INSURANCE SERVICES, INC. Filed as: CHUN-HA INSURANCE SERVICES INC | — | CIGNA | $32 | — | $32 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA | Non-monetary compensation; Contract Administrator; Other services; Direct payment from the plan; Float revenue; Participant communication; Claims processing; Named fiduciary Service code 12 | — | $0 |
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 | 251 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA | 381 | $0 |
| Dental(2 contracts, 2 carriers) | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 631 | $207K |
| Vision | EYEMED VISION CARE | 627 | $33K |
| Life insurance(2 contracts, 2 carriers) | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 275 | $16K |
| Long-term disability(2 contracts, 2 carriers) | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 274 | $29K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 275 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 631 | — |
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.