| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | INSURANCE SERVICES PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | $45K | — | $45K | 2.87% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEITS & INSURANCE SERVICES, | INC. 160 W SANTA CLARA ST STE 450 SAN JOSE, CA 951131762 | KAISER FOUNDATION HEALTH PLAN INC | -$131 | — | -$131 | -0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES INC. 4371 LATHAM ST SUITE 101 RIVERSIDE, CA 92501 | CALIFORNIA PHYSICIANS' SERVICE | $5K | $42K | $47K | 3.02% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS & IN SVCS INC | 10474 SANTA MONICA BLVD STE 200 LOS ANGELES, CA 90025 | CALIFORNIA PHYSICIANS' SERVICE | $5K | — | $5K | 0.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3390 UNIVERSITY AVE STE 300 RIVERSIDE, CA 92501 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $24K | $4K | $29K | 11.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | SERVICES INC. 4371 LATHAM ST SUITE 101 RIVERSIDE, CA 92501 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $9K | $527 | $10K | 7.96% |
| CBIZ BENEFITS & INSURANCE SERVICES3 | INC P O BOX 632886 CINCINNATI, OH 45263 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $248 | — | $248 | 0.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3390 UNIVERSITY AVE STE 300 RIVERSIDE, CA 92501 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $607 | $5K | 11.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3390 UNIVERSITY AVE STE 300 RIVERSIDE, CA 92501 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | $472 | $3K | 11.59% |
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 | 290 | 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) | 290 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 255 | $3.1M |
| Dental(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 155 | $275K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 485 | $121K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 485 | $121K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 240 | $41K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 255 | $1.5M |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 485 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 485 | — |
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.