| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 4047 CONCORD, CA 94524 | BLUE CROSS OF CALIFORNIA | $28K | $2K | $30K | 4.61% |
| HEATH BENEFIT PARTNERS INSURANCE3 Filed as: HEATH BENEFIT PTNRS. INS. SOLUTIONS | 26522 LA ALAMEDA, SUITE 130 MISSION VIEJO, CA 92691 | BLUE CROSS OF CALIFORNIA | $6K | $0 | $6K | 0.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC | $19K | $0 | $19K | 3.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $180 | $180 | 0.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | UNKNOWN SAN FRANCISCO, CA 94115 | DELTA DENTAL OF CALIFORNIA | $4K | $0 | $4K | 5.00% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | UNKNOWN SAN FRANCISCO, CA 94115 | DELTA DENTAL OF CALIFORNIA | $863 | $0 | $863 | 1.00% |
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 | 107 | 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) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 107 | $1.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 156 | $86K |
| Vision | BLUE CROSS OF CALIFORNIA | 107 | $660K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 107 | $660K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 107 | $660K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 107 | $1.2M |
| Other | BLUE CROSS OF CALIFORNIA | 107 | $660K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.