| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $24K | $5 | $24K | 3.19% |
| TAS INSURANCE SERVICES INC3 Filed as: TAS INSURANCE SERVICES | 8941 ATLANTA AVENUE, SUITE 359 HUNTINGTON BEACH, CA 92646 | KAISER FOUNDATION HEALTH PLAN, INC. | $16K | $86 | $16K | 2.14% |
| TIM ALAN SKAGGS3 | 8941 ATLANTA AVENUE, SUITE 359 HUNTINGTON BEACH, CA 92646 | UNITEDHEALTHCARE INSURANCE COMPANY | $9K | $0 | $9K | 3.37% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP INC | 1000 BURNETT AVENUE, SUITE 330 CONCORD, CA 94520 | UNITEDHEALTHCARE INSURANCE COMPANY | $6K | $0 | $6K | 2.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | UNITEDHEALTHCARE INSURANCE COMPANY | $6K | $0 | $6K | 2.14% |
| AP DESIGN PROFESSIONALS INS. SVCS.3 | 3697 MT DIABLO BOULEVARD, SUITE 230 LAFAYETTE, CA 94549 | UNITEDHEALTHCARE INSURANCE COMPANY | $890 | $0 | $890 | 0.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 16030 VENTURA BOULEVARD, SUITE 500 ENCINO, CA 91436 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $0 | $5K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $5K | $5K | 5.86% |
| TAS INSURANCE SERVICES INC3 Filed as: TAS INSURANCE SERVICES | 8941 ATLANTA AVENUE, SUITE 359 HUNTINGTON BEACH, CA 92646 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.00% |
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 | 163 | 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) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 195 | $1.0M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $87K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $87K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $87K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 195 | $1.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 163 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 195 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.