| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 4047 CONCORD, CA 94524 | ANTHEM BLUE CROSS | $22K | $1 | $22K | 1.31% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA RD WESTLAKE VILLAGE, CA 91361 | ANTHEM BLUE CROSS | — | $18K | $18K | 1.10% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SERVICES, INC. | 7701 AIRPORT CENTER DRIVE GREENSBORO, NC 27409 | ANTHEM BLUE CROSS | $15K | — | $15K | 0.89% |
| MCGRIFF INSURANCE SERVICES INC3 | 130 THEORY STE 200 IRVINE, CA 926173065 | KAISER FOUNDATION HEALTH PLAN INC | $8K | — | $8K | 3.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | $5K | — | $5K | 2.23% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVCS., INC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 913614026 | KAISER FOUNDATION HEALTH PLAN INC | $5K | — | $5K | 2.14% |
| MCGRIFF INSURANCE SERVICES INC3 | 130 THEORY STE 200 IRVINE, CA 926173065 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | — | $8K | 3.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA INS | PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $2K | $5K | 2.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 40 E ALAMAR AVE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $3K | $8K | 6.36% |
| MCGRIFF INSURANCE SERVICES INC3 | 750 B ST STE 2400 SAN DIEGO, CA 92101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 6.32% |
| ADP INC5 Filed as: AUTOMATIC DATA PROCESSING INC | PO BOX 842875 BOSTON, MA 02284 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 3.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 40 E ALAMAR AVE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $902 | $3K | 9.68% |
| MCGRIFF INSURANCE SERVICES INC3 | 750 B ST STE 2400 SAN DIEGO, CA 92101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 8.73% |
| ADP INC5 Filed as: AUTOMATIC DATA PROCESSING INC | PO BOX 842875 BOSTON, MA 02284 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 7.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 40 E ALAMAR AVE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $880 | $2K | 9.35% |
| MCGRIFF INSURANCE SERVICES INC3 | 750 B ST STE 2400 SAN DIEGO, CA 92101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.23% |
| FMLASOURCE INC5 | 455 N CITYFRONT PLZ DR 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 5.40% |
| MCGRIFF INSURANCE SERVICES INC3 | 750 B ST STE 2400 SAN DIEGO, CA 92101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 40 E ALAMAR AVE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $612 | $2K | 8.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 40 E ALAMAR AVE SANTA BARBARA, CA 93105 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $778 | $476 | $1K | 9.37% |
| MCGRIFF INSURANCE SERVICES INC3 | 750 B ST STE 2400 SAN DIEGO, CA 92101 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 9.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS | PO BOX 5345 RIVERSIDE, CA 92517 | CALIFORNIA DENTAL NETWORK, INC. | $404 | — | $404 | 5.11% |
| MCGRIFF INSURANCE SERVICES INC3 Filed as: MCGRIFF INSURANCE SVCS | PO BOX 896620 CHARLOTTE, NC 28289 | CALIFORNIA DENTAL NETWORK, INC. | $386 | — | $386 | 4.88% |
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 | 243 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 258 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | ANTHEM BLUE CROSS | 230 | $2.1M |
| Dental(3 contracts, 3 carriers) | ANTHEM BLUE CROSS | 238 | $1.8M |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 232 | $19K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 301 | $13K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 26 | $27K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 301 | $25K |
| Prescription drug(3 contracts, 2 carriers) | ANTHEM BLUE CROSS | 230 | $2.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 301 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 301 | — |
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.