Form 5500 · Employee benefit plan · COLMA, CA
LUCKY CHANCES, INC
LUCKY CHANCES, INC of COLMA, CA insures dental, vision and life coverage for its employees, per Schedule A of its Form 5500. Its broker of record is HUB INTERNATIONAL INS SERVICES. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 94-3199406 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 3 insured contracts covering dental, vision and life; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 527 people.
Reported premium across the insured contracts is $132,685, with $13,268 in disclosed broker commissions — about 10% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL INS SERVICES is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing — UNITED OF OMAHA LIFE INSURANCE COMPANY, VISION SERVICE PLAN and SUN LIFE ASSURANCE COMPANY OF CANADA — with UNITED OF OMAHA LIFE INSURANCE COMPANY writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 527 | December | $115,924 | $11,592 |
| VISION SERVICE PLAN | Vision | 173 | December | $11,211 | $1,121 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Dental | 27 | December | $5,550 | $555 |
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