| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $30K | $0 | $30K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | CALIFORNIA PHYSICIANS' SERVICE | $61K | $0 | $61K | 5.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | UNKNOWN NORTHRIDGE, CA 91325 | DELTA DENTAL OF CALIFORNIA | $7K | $0 | $7K | 5.00% |
| GARY RANDY RIDER3 | UNKNOWN NORTHRIDGE, CA 91325 | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH | $10K | $0 | $10K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 15.00% |
| BRANDON TYLOR-DA SHIRLEY3 Filed as: BRANDON TYLOR-DAVID SHIRLEY | 5110 SOUTH SHERBOURNE DRIVE LOS ANGELES, CA 90056 | CONTINENTAL AMERICAN INSURANCE COMPANY | $683 | $0 | $683 | 6.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $663 | $0 | $663 | 6.53% |
| CHRISTOPHER UNDERWOOD3 Filed as: CHRISTOPHER CHARLES EVANS | 5805 NORTH SEPULVEDA BOUELVARD SUITE 740 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $158 | $0 | $158 | 1.56% |
| CARLOS DAVID HERNANDEZ3 | 4738 WEST 136TH STREET HOWTHOME, CA 90250 | CONTINENTAL AMERICAN INSURANCE COMPANY | $140 | $0 | $140 | 1.38% |
| JEFFERY MICHAEL SATTERLEE3 | 4351 JAGER DRIVE NE, SUITE B RIO RANCHO, NM 87144 | CONTINENTAL AMERICAN INSURANCE COMPANY | $112 | $0 | $112 | 1.10% |
| RENEE SUZANNE CORSO3 | 2206 NORTH LAMER STREET BURBANK, CA 91504 | CONTINENTAL AMERICAN INSURANCE COMPANY | $91 | $0 | $91 | 0.90% |
| RICHARD JOSEPH KUNZ3 | 118 GRANVILLE WAY SAN FRANCISCO, CA 94127 | CONTINENTAL AMERICAN INSURANCE COMPANY | $86 | $0 | $86 | 0.85% |
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 | 259 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 243 | $2.7M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 342 | $144K |
| Vision | VISION SERVICE PLAN | 208 | $26K |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH | 263 | $67K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 243 | $2.7M |
| Other(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH | 263 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 342 | — |
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."
No prospect flags tripped on this filing.