| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 255387 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN INC | $30K | $0 | $30K | 4.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $91 | $91 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | WESTERN HEALTH ADVANTAGE | $10K | $0 | $10K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | 3636 AMERICAN RIVER DRIVE SUITE 200 SACRAMENTO, CA 95864 | DELTA DENTAL OF CALIFORNIA | $8K | $0 | $8K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3636 AMERICAN RIVER DRIVE SUITE 200 SACRAMENTO, CA 95864 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $9K | $0 | $9K | 16.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 EAST JACKSON BOULEVARD 12TH FLOOR CHICAGO, IL 60604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3636 AMERICAN RIVER DRIVE SUITE 200 SACRAMENTO, CA 95864 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $729 | $0 | $729 | 6.00% |
| BB&T INSURANCE SERVICES, INC.3 Filed as: CHIMIENTI AND ASSOC. INS. SERIVCES | 3400 WEST MINERAL KING, SUITE B VISALIA, CA 93291 | AMERICAN FIDELITY ASSURANCE COMPANY | $599 | $0 | $599 | 30.33% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF ROAD, 4TH FLOOR ROLLING MEADOWS, IL 60008 | AMERICAN FIDELITY ASSURANCE COMPANY | $159 | $0 | $159 | 8.05% |
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 | 140 | 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) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 91 | $859K |
| Dental | DELTA DENTAL OF CALIFORNIA | 147 | $83K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 68 | $12K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 140 | $54K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 140 | $54K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 140 | $54K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 91 | $859K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 140 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 147 | — |
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.