| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVE STE 300 RIVERSIDE, CA 925013315 | KAISER FOUNDATION HEALTH PLAN INC | — | $5K | $5K | 0.54% |
| ALLIANT INSURANCE SERVICES, INC.3 | 701 B ST FL 6 SAN DIEGO, CA 921018156 | KAISER FOUNDATION HEALTH PLAN INC | — | $479 | $479 | 0.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL EIN 33-0315047 N/A | Direct payment from the plan; Insurance brokerage commissions and fees Service code 50 | — | $330K |
| POLYCOMP ADMINISTRATIVE SERVICES EIN 95-2889854 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $161K |
| ABC-NCC EIN 92-3378739 PLAN SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $109K |
| WOLDS LAW GROUP EIN 80-0462356 N/A | Legal; Direct payment from the plan Service code 29 | — | $105K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $50K |
| FRINGE BENEFIT GROUP, INC. N/A | Direct payment from the plan; Insurance agents and brokers Service code 22 | 11910 ANDERSON MILL ROAD, STE 401 AUSTIN, TX 78726 | $25K |
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 | 871 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 871 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 739 | $7.6M |
| Dental(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 739 | $6.8M |
| Vision | VISION SERVICE PLAN | 602 | $26K |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INS CO | 931 | $59K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 739 | $7.6M |
| Other | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INS CO | 931 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 931 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.