| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $35K | $621 | $36K | 4.50% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS INC | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $639 | $639 | 0.08% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS INC | 3010 LAVA RIDGE COURTSUITE 110 STE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $50 | $50 | 0.01% |
| DDC BROKER - DIGITAL INSURANCE3 | 400 GALLERIA PARKWAY SUITE 300 ATLANTA, GA 303393182 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 4.00% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 400 GALLERIA PARKWAY STE 300 ATLANTA, GA 30339 | PRUDENTIAL | $5K | — | $5K | 19.43% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 400 GALLERIA PARKWAY STE 300 ATLANTA, GA 30339 | PRUDENTIAL | — | $3K | $3K | 11.88% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE STE 1100 CHICAGO, IL 60603 | PRUDENTIAL | — | $40 | $40 | 0.15% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE INC | 400 GALLERIA PARKWAY SUITE 300 ATLANTA, GA 303393182 | DELTA DENTAL OF CALIFORNIA | $33 | — | $33 | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | HOLMAN PROFESSIONAL COUNSELING CENTERS | $246 | — | $246 | 5.01% |
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 | 113 | 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) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 339 | $861K |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 139 | $90K |
| Vision | WISCONSIN VISION SERVICE PLAN, INC. | 110 | $14K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS | 339 | $90K |
| Long-term disability | PRUDENTIAL | 112 | $17K |
| Other(2 contracts, 2 carriers) | HOLMAN PROFESSIONAL COUNSELING CENTERS | 130 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 339 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.