| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC. | $48K | $34 | $48K | 3.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 1903 WRIGHT PLACE, SUITE 330 CARLSBAD, CA 92008 | PREMIER ACCESS INSURANCE COMPANY | $11K | — | $11K | 9.71% |
| EDITH ANDERSON3 | 215 PACIFIC AVE. PASO ROBLES, CA 93446 | PRINCIPAL LIFE INSURANCE COMPANY | — | — | $0 | — |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 201 RIVERSIDE, CA 92517 | PRINCIPAL LIFE INSURANCE COMPANY | — | — | $0 | — |
| PALM CANYON INSURANCE SERVICES, LLC3 | 4330 LA JOLLA VILLAGE DR., STE. 330 SAN DIEGO, CA 92122 | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | — |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 3635 RIVERSIDE PLAZA DR. BLDG M3 SUITE 320 RIVERSIDE, CA 92506 | UNITED HEALTHCARE INSURANCE COMPANY | — | — | $0 | — |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 189 | $1.2M |
| Dental(2 contracts, 2 carriers) | PREMIER ACCESS INSURANCE COMPANY | 278 | $112K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 0 | $0 |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 0 | $0 |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 189 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.