| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | KAISER FOUNDATION HEALTH PLAN, INC. | $21K | $0 | $21K | 2.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 255387 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN, INC. | $15K | $0 | $15K | 2.06% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 1100 LARKSPUR LANDING CIRCLE SUITE 180 LARKSPUR, CA 94939 | WESTERN HEALTH ADVANTAGE | $8K | $0 | $8K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | 970 RESERVE DRIVE ROSEVILLE, CA 95678 | WESTERN HEALTH ADVANTAGE | $5K | $0 | $5K | 3.41% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | DELTA DENTAL OF CALIFORNIA | $5K | $0 | $5K | 5.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 255387 SACRAMENTO, CA 95865 | DELTA DENTAL OF CALIFORNIA | $4K | $0 | $4K | 4.25% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | $0 | $7K | 9.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 255387 SACRAMENTO, CA 95865 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 7.25% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | METROPOLITAN LIFE INSURANCE COMPANY | $580 | $0 | $580 | 3.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 255387 SACRAMENTO, CA 95865 | METROPOLITAN LIFE INSURANCE COMPANY | $378 | $0 | $378 | 2.35% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: HUB INTERNATIONAL INS. | PO BOX 2158 RIVERSIDE, CA 92516 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $169 | $0 | $169 | 5.30% |
| RICHARD E. DUMONT INC4 Filed as: RICHARD DUMONT INC | PO BOX 929 NEWCASTLE, CA 95658 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $107 | $0 | $107 | 3.35% |
| LUCKSON EMMANUEL4 | 425 LENOX COURT ROSEVILLE, CA 95661 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $51 | $0 | $51 | 1.60% |
| BURNHAM BENEFITS INSURANCE SERVICES4 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $30 | $0 | $30 | 0.94% |
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 | 128 | 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) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 93 | $888K |
| Dental | DELTA DENTAL OF CALIFORNIA | 161 | $93K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 103 | $16K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 131 | $71K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 131 | $71K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 131 | $71K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 93 | $888K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 131 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 161 | — |
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."
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.