| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 2158 RIVERSIDE, CA 925162158 | CALIFORNIA PHYSICIANS SERVICE | — | $9K | $9K | 0.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | — | $2K | $2K | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 2158 RIVERSIDE, CA 925162158 | UNITED CONCORDIA INSURANCE COMPANY | — | $9K | $9K | 5.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | — | $22 | $22 | 0.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL EIN 33-0315047 N/A | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $633K |
| FRINGE BENEFIT GROUP, INC. N/A | Direct payment from the plan; Insurance agents and brokers; Contract Administrator Service code 13 | 11910 ANDERSON MILL ROAD, STE 401 AUSTIN, TX 78726 | $293K |
| GAROFOLO & RAMSDELL, LLP N/A | Legal; Direct payment from the plan Service code 29 | 3443 GOLDEN GATE WAY H LAFAYETTE, CA 94549 | $136K |
| ABC-NCC EIN 92-3378739 PLAN SPONSOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $106K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $45K |
| CHARLES SCHWAB N/A | Investment management; Investment management fees paid directly by plan Service code 28 | 6200 STONEBRIDGE MAIL ROAD PLEASANTON, CA 94588 | $6K |
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 | 1,320 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 923 | $6.5M |
| Dental(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 643 | $4.9M |
| Vision | VISION SERVICE PLAN | 897 | $55K |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INS CO | 1,343 | $65K |
| Prescription drug(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 923 | $6.5M |
| Other | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INS CO | 1,343 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,343 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.