| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $15K | $133 | $16K | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | CALIFORNIA PHYSICIANS SERVICE | $0 | $66K | $66K | 5.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | 4696 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | DELTA DENTAL OF CALIFORNIA | $12K | $0 | $12K | 5.00% |
| GARY RANDY RIDER3 | UNKNOWN NORTHRIDGE, CA 91325 | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH | $12K | $0 | $12K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | 40 EAST ALAMAR AVENUE SANTA BARBARA, CA 93105 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 14.84% |
| CHRISTOPHER UNDERWOOD3 Filed as: CHRISTOPHER EVANS AND OTHER AGENTS | 5805 NORTH SEPULVEDA BOULEVARD SUITE 740 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $334 | $0 | $334 | 3.96% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 5345 RIVERSIDE, CA 92517 | CONTINENTAL AMERICAN INSURANCE COMPANY | $264 | $0 | $264 | 3.13% |
| RENEE SUZANNE CORSO3 Filed as: RENEE S. CORSO | 5805 SEPULVEDA BOULEVARD SUITE 740 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $200 | $0 | $200 | 2.37% |
| MICHELE B. COSTA3 | 818 12TH STREET SANTA MONICA, CA 90403 | CONTINENTAL AMERICAN INSURANCE COMPANY | $120 | $0 | $120 | 1.42% |
| YOLANDA JOY RICHMAN3 Filed as: YOLANDA J. RICHMAN | 10000 NEVADA AVENUE CHATSWORTH, CA 91311 | CONTINENTAL AMERICAN INSURANCE COMPANY | $108 | $0 | $108 | 1.28% |
| RICHARD J KUNZ3 Filed as: RICHARD J. KUNZ | 1155 NORTH MICHIGAN AVENUE PASADENA, CA 91104 | CONTINENTAL AMERICAN INSURANCE COMPANY | $70 | $0 | $70 | 0.83% |
| AMY EVANS3 | 14358 MAGNOLIA BOULEVARD APARTMENT 103 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $55 | $0 | $55 | 0.65% |
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 | 308 | 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) | 308 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 244 | $2.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 463 | $241K |
| Vision | VISION SERVICE PLAN | 232 | $29K |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH | 340 | $81K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 244 | $2.8M |
| Other(3 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH | 340 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 463 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.