| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE CLERK3 | 1055 E. COLORADO BLVD. PASADENA, CA 91106 | KAISER FOUNDATION HEALTH PLAN INC. | $47K | — | $47K | 3.00% |
| JERROLD SMITH3 | 5700 WILSHIRE BLVD. LOS ANGELES, CA 90036 | KAISER FOUNDATION HEALTH PLAN INC. | $32K | — | $32K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | KAISER FOUNDATION HEALTH PLAN INC. | $15K | — | $15K | 0.93% |
| INSURANCE CLERK3 | 1055 E. COLORADO BLVD. PASADENA, CA 91106 | CALIFORNIA PHYSICIANS SERVICE | — | $22K | $22K | 2.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | CALIFORNIA PHYSICIANS SERVICE | — | $18K | $18K | 1.95% |
| JERROLD SMITH3 | 5700 WILSHIRE BLVD. LOS ANGELES, CA 90036 | CALIFORNIA PHYSICIANS SERVICE | — | $16K | $16K | 1.77% |
| UNLIMITED LIFE INSURANCE SOLUTIONS3 | 21021 VENTURA BLVD. WOODLAND HILLS, CA 91364 | CALIFORNIA PHYSICIANS SERVICE | — | $8K | $8K | 0.87% |
| CAPITAL CITY BENEFITS3 | 400 SUNRISE AVENUE ROSEVILLE, CA 95661 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $100 | $8K | 6.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $5K | $5K | 4.14% |
| JERROLD SMITH3 | 5700 WILSHIRE BLVD. LOS ANGELES, CA 90036 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 4.00% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. | 3 PARKWAY NORTH DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $29 | $29 | 0.02% |
| CAPITAL CITY BENEFITS3 | 400 SUNRISE AVENUE ROSEVILLE, CA 95661 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $49 | $3K | 9.18% |
| JERROLD SMITH3 | 5700 WILSHIRE BLVD. LOS ANGELES, CA 90036 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 6.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 4.14% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. | 3 PARKWAY NORTH DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $14 | $14 | 0.05% |
| CAPITAL CITY BENEFITS3 | 400 SUNRISE AVENUE ROSEVILLE, CA 95661 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $29 | $1K | 6.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $738 | $738 | 4.14% |
| JERROLD SMITH3 | 5700 WILSHIRE BLVD. LOS ANGELES, CA 90036 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $713 | — | $713 | 4.00% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. | 3 PARKWAY NORTH DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8 | $8 | 0.04% |
| CAPITAL CITY BENEFITS3 | 400 SUNRISE AVENUE PASADENA, FL 95561 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $430 | $12 | $442 | 6.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $297 | $297 | 4.15% |
| JERROLD SMITH3 | 5700 WILSHIRE BLVD. LOS ANGELES, CA 90036 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $286 | — | $286 | 3.99% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. | 3 PARKWAY NORTH DEERFIELD, IL 60015 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3 | $3 | 0.04% |
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 | 262 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 175 | $2.5M |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 247 | $125K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 241 | $18K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 262 | $35K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 175 | $2.5M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 262 | $35K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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.