| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $44K | $595 | $45K | 14.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | 8350 EAST RAINTREE SUITE 235 SCOTTSDALE, AZ 85260 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $6K | $523 | $6K | 10.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $595 | $595 | 0.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | $2K | $0 | $2K | 4.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALI | 580 CALIFORNIA ST SAN FRANSISCO, CA 94104 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $755 | $3K | 7.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALI | 580 CALIFORNIA ST SAN FRANSISCO, CA 94104 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $1K | $3K | 10.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALI | 580 CALIFORNIA ST SAN FRANSISCO, CA 94104 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $1K | $2K | 20.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALI | 580 CALIFORNIA ST SAN FRANSISCO, CA 94104 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $249 | $128 | $377 | 12.34% |
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 | 211 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 216 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 193 | $357K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 141 | $60K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 141 | $60K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 308 | $27K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 211 | $33K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 211 | $12K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 309 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 309 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.