| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $71K | $4K | $75K | 5.29% |
| RICHARD BLAINE HUBER3 | PO BOX 7220 REDLANDS, CA 92375 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | $0 | $17K | 13.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 9595 WILSHIRE BLVD STE 801 BEVERLY HILLS, CA 90212 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $0 | $9K | 7.25% |
| JEFFERY P RABBETTS3 Filed as: JEFFERY PHILIP RABBETTS | 19240 BOX CANYON RD CORONA, CA 92881 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 3.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 9595 WILSHIRE BOULEVARD SUITE 801 BEVERLY HILLS, CA 90212 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.65% |
| THERESA M VAUGHN3 Filed as: THERESA VAUGHN | PO BOX 255 NORCO, CA 92860 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.47% |
| JEFFERY P RABBETTS3 Filed as: JEFFERY PHILIP RABBETTS | 19240 BOX CANYON RD CORONA, CA 92860 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $816 | $0 | $816 | 0.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $0 | $6K | 7.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | 3390 UNIVERSITY AVENUE SUITE 300 RIVERSIDE, CA 92501 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $882 | $0 | $882 | 1.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE #300 RIVERSIDE, CA 92501 | DENTAL HEALTH SERVICES | $3K | $0 | $3K | 10.00% |
| PATRICK JOYCE3 | 25909 PALA PLACE #250 MISSION VIEJO, CA 92691 | DENTAL HEALTH SERVICES | $785 | $0 | $785 | 3.00% |
| RICHARD BLAINE HUBER3 | PO BOX 501623 SAN DIEGO, CA 92150 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 13.14% |
| RICHARD BLAINE HUBER3 | PO BOX 7220 REDLANDS, CA 92375 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 13.14% |
| JEFFREY P. RABBETTS3 | 19240 BOX CANYON ROAD CORONA, CA 92881 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $145 | $0 | $145 | 1.77% |
| THERESA M VAUGHN3 Filed as: THERESA MARIE VAUGHN | PO BOX 255 NORCO, CA 92860 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $106 | $0 | $106 | 1.29% |
| CHIMIENTI & ASSOCIATES3 Filed as: CHIMIENTI AND ASSOC INS. SVCES. | 3400 WEST MINERAL KING AVENUE SUITE B VISALIA, CA 93291 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $43 | $0 | $43 | 0.53% |
| BRIAN EDWARD JUND3 | 23282 MILL CREEK DRIVE, SUITE 390 LAGUNA HILLS, CA 92653 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $27 | $0 | $27 | 0.33% |
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 | 275 | 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) | 276 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 371 | $1.4M |
| Dental(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 234 | $106K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 234 | $80K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 234 | $209K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $129K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 95 | $129K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 371 | $1.4M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 234 | $217K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 371 | — |
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.