| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $27K | — | $27K | 3.40% |
| ORION BUSINESS INSURANCE3 | 1250 CORONA POINTE COURT, SUITE 302 CORONA, CA 92879 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | — | $13K | 1.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O. BOX 2158 RIVERSIDE, CA 92516 | UNITED HEALTHCARE INSURANCE COMPANY | $1K | — | $1K | 5.50% |
| ORION BUSINESS INSURANCE3 | 1250 CORONA POINTE COURT, SUITE 302 RIVERSIDE, CA 92879 | UNITED HEALTHCARE INSURANCE COMPANY | $901 | — | $901 | 3.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O BOX 2158 RIVERSIDE, CA 92516 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $324 | $3K | 12.35% |
| ORION BUSINESS INSURANCE3 | 1250 CORONA POINTE COURT, SUITE 302 CORONA, CA 92879 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $914 | — | $914 | 4.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | P.O BOX 2158 RIVERSIDE, CA 92516 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $928 | $186 | $1K | 8.72% |
| ORION BUSINESS INSURANCE3 | 1250 CORONA POINTE COURT, SUITE 302 CORONA, CA 92879 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $349 | — | $349 | 2.73% |
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 | 117 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 108 | $784K |
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 104 | $27K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 104 | $27K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $35K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 108 | $784K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 117 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 117 | — |
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.