| 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. | $62K | $0 | $62K | 3.68% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 1 POLARIS WAY, SUITE 300 ALISO VIEJO, CA 92656 | KAISER FOUNDATION HEALTH PLAN, INC. | $22K | $0 | $22K | 1.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | PO BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $17K | $387 | $17K | 9.61% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 161 WASHINGTON STREET, SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED CONCORDIA INSURANCE COMPANY | $10K | $5K | $15K | 10.05% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | PO BOX 741259 LOS ANGELES, CA 90074 | UNITED CONCORDIA INSURANCE COMPANY | $5K | $0 | $5K | 3.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $10K | $748 | $10K | 7.35% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | 1 POLARIS WAY, SUITE 300 ALISO VIEJO, CA 92656 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | $0 | $6K | 3.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $2K | $0 | $2K | 10.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | PO BOX 412703 BOSTON, MA 02241 | VISION SERVICE PLAN | $590 | $0 | $590 | 3.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $963 | $481 | $1K | 10.31% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH AND MCLENNAN AGENCY | PO BOX 741259 LOS ANGELES, CA 90074 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $326 | $0 | $326 | 2.33% |
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 | 257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 259 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 246 | $1.8M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 261 | $161K |
| Vision | VISION SERVICE PLAN | 180 | $18K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 257 | $179K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 257 | $179K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 257 | $179K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 246 | $1.8M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 257 | $179K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 261 | — |
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.