| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUMITY, INC.3 Filed as: LUMITY INC | 5214F DIAMOND HEIGHTS BOULEVARD SUITE 1152 SAN FRANCISCO, CA 94131 | BLUE CROSS OF CALIFORNIA | $67K | $1K | $68K | 1.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 2120 PEWAUKEE ROAD, SUITE 202 WAUKESHA, WI 53188 | BLUE CROSS OF CALIFORNIA | $63K | $0 | $63K | 1.35% |
| ARCHON LLC3 | 1209 ORANGE STREET WILMINGTON, DE 19801 | BLUE CROSS OF CALIFORNIA | $0 | $17K | $17K | 0.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | PO BOX 4047 CONCORD, CA 94524 | BLUE CROSS OF CALIFORNIA | $0 | $6K | $6K | 0.13% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS, INC. | 225 WIRELESS BOULEVARD, SUITE 200 HAUPPAUGE, NY 11788 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $20K | $20K | 4.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | PO BOX 2167 GRAND RAPIDS, MI 49501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $12K | $0 | $12K | 2.76% |
| LUMITY, INC.3 Filed as: LUMITY INC | 5214F DIAMOND HEIGHTS BOULEVARD SUITE 1152 SAN FRANCISCO, CA 94131 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $10K | $0 | $10K | 2.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | $0 | $1K | 1.59% |
| LUMITY, INC.3 Filed as: LUMITY INC | 71 EAST 3RD AVENUE SAN MATEO, CA 94401 | KAISER FOUNDATION HEALTH PLAN, INC. | $930 | $0 | $930 | 1.24% |
| LUMITY, INC.3 Filed as: LUMITY INC. | 71 EAST 3RD AVENUE SAN MATEO, CA 94401 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | $0 | $2K | 3.44% |
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 | 466 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 486 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 881 | $4.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 474 | $452K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 474 | $452K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 881 | $4.6M |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 881 | $4.6M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 881 | $4.6M |
| Other | BLUE CROSS OF CALIFORNIA | 881 | $4.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 881 | — |
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.