| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 2120 PEWAUKEE ROAD, SUITE 202 WAUKESHA, WI 53188 | BLUE CROSS OF CALIFORNIA | $26K | $0 | $26K | 3.37% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 423 MCGOARTY STREET SAN GABRIEL, CA 91776 | BLUE CROSS OF CALIFORNIA | $12K | $0 | $12K | 1.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC | PO BOX 4047 CONCORD, CA 94524 | BLUE CROSS OF CALIFORNIA | $0 | $1K | $1K | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $0 | $12K | 3.29% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 28202 CABOT ROAD, SUITE 600 LAGUNA NIGUEL, CA 92677 | KAISER FOUNDATION HEALTH PLAN INC | $4K | $0 | $4K | 1.23% |
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 | 91 | 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) | 91 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 205 | $1.1M |
| Dental | BLUE CROSS OF CALIFORNIA | 205 | $773K |
| Vision | BLUE CROSS OF CALIFORNIA | 205 | $773K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 205 | $773K |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 205 | $773K |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 205 | $773K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 205 | $1.1M |
| Other | BLUE CROSS OF CALIFORNIA | 205 | $773K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 205 | — |
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.