| 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. | $33K | $2 | $33K | 3.18% |
| GARY CHRISTOPHER JENNISON3 Filed as: GARY CHRISOPHER JENNISON | 216 GRAND CANAL BALBOA ISLAND, CA 92662 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | $0 | $11K | 1.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | PROMINENCE HEALTH PLAN | $20K | $0 | $20K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | UNKNOWN LA HABRA, CA 90631 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $21K | $559 | $22K | 5.43% |
| GARY C. JENNISON3 Filed as: GARY C JENNISON | UNKNOWN LA HABRA, CA 90631 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $11K | $0 | $11K | 2.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | UNKNOWN LA HABRA, CA 90631 | DELTA DENTAL OF CALIFORNIA | $12K | $0 | $12K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | AMERITAS LIFE INSURANCE CORP. | $2K | $0 | $2K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 40 EAST ALAMAR AVENUE SANTA BARBARA, CA 93105 | AMERITAS LIFE INSURANCE CORP. | $0 | $393 | $393 | 1.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 4047 CONCORD, CA 94524 | BLUE CROSS OF CALIFORNIA | $2K | $1K | $3K | 18.81% |
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 | 221 | 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) | 221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 190 | $1.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 252 | $122K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 418 | $25K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 221 | $17K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 190 | $1.8M |
| Other | BLUE CROSS OF CALIFORNIA | 221 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 418 | — |
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.