| 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 925162158 | KAISER FOUNDATION HEALTH PLAN INC | $28K | $2K | $30K | 2.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC | 3655 NOBEL DR STE 450 SAN DIEGO, CA 921221071 | KAISER FOUNDATION HEALTH PLAN INC | $14K | — | $14K | 0.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 3390 UNIVERSITY AVE STE 300 RIVERSIDE, CA 92501 | STANDARD INSURANCE COMPANY | $6K | — | $6K | 6.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 25909 PALA STE 120 MISSION VIEJO, CA 92691 | STANDARD INSURANCE COMPANY | $3K | — | $3K | 3.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE LIMITED | 1065 AVE OF THE AMERICAS NEW YORK, NY 10018 | STANDARD INSURANCE COMPANY | $486 | — | $486 | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | ATTN ACCOUNTING DEPT PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INS CO | $4K | $3K | $7K | 16.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3655 NOBEL DR STE 450 SAN DIEGO, CA 92122 | UNITED OF OMAHA LIFE INS CO | $2K | — | $2K | 4.96% |
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 | 129 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 115 | $1.5M |
| Dental | STANDARD INSURANCE COMPANY | 108 | $97K |
| Vision | KAISER FOUNDATION HEALTH PLAN INC | 115 | $1.5M |
| Life insurance | UNITED OF OMAHA LIFE INS CO | 129 | $44K |
| Long-term disability | UNITED OF OMAHA LIFE INS CO | 129 | $44K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 115 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 129 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.