| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92260 | KAISER FOUNDATION HEALTH PLAN INC. | $48K | — | $48K | 2.82% |
| LEAVITT GROUP3 Filed as: LEAVITT BENEFIT INS SVCS OF SO CA | 1820 EAST 1ST STREET, SUITE 500 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN INC. | $38K | — | $38K | 2.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 5.87% |
| LEAVITT GROUP3 Filed as: LEAVITT INS SVCS OF SO CA | 1820 EAST FIRST STREET, SUITE 500 SANTA ANA, CA 92705 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 2.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | EYEMED VISION CARE | $796 | — | $796 | 6.45% |
| LEAVITT GROUP3 Filed as: LEAVITT BENEFITS INSURANCE SERVICES | 1820 EAST 1ST STREET, SUITE 500 SANTA ANA, CA 92705 | EYEMED VISION CARE | $568 | — | $568 | 4.60% |
| LEAVITT GROUP3 Filed as: LEAVITT INS SVCS OF SO CA | 1820 EAST FIRST STREET, SUITE 500 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | $477 | — | $477 | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | BLUE CROSS OF CALIFORNIA | $217 | — | $217 | 3.57% |
| LEAVITT GROUP3 Filed as: LEAVITT INS SVCS OF SO CA | 1820 EAST FIRST STREET, SUITE 500 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | $43 | — | $43 | 0.71% |
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 | 387 | 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) | 387 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 311 | $1.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $143K |
| Vision | EYEMED VISION CARE | 170 | $12K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $143K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 311 | $1.7M |
| Other(3 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $159K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.