| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INSURANCE SVCS INC | P.O. BOX 632886 CINCINNATI, OH 45263 | AETNA HEALTH, INC | $44K | — | $44K | 2.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | AETNA HEALTH, INC | $15K | — | $15K | 0.95% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES, INC. | 160 W SANTA CLARA ST STE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC | $28K | — | $28K | 3.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 1.98% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES, INC. | 2301 DUPORT DR 2ND FLOOR IRVINE, CA 92612 | PREMIER ACCESS INSURANCE COMPANY | $3K | — | $3K | 2.79% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE | 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | PREMIER ACCESS INSURANCE COMPANY | $2K | — | $2K | 1.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | PO BOX 2158 RIVERSIDE, CA 92516 | PREMIER ACCESS INSURANCE COMPANY | $452 | — | $452 | 0.38% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & INS SERVICES, INC. | P.O. BOX 632886 CINCINNATI, OH 45263 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 6.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVCES, INC | PO BOX 2158 RIVERSIDE, CA 92517 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 3.40% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $58 | $58 | 0.14% |
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 | 166 | 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) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA HEALTH, INC | 256 | $2.2M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 487 | $120K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 166 | $42K |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 166 | $42K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 166 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 487 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.