| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $53K | $0 | $53K | 5.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $16K | $407 | $17K | 10.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | PO BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | $0 | $15K | 16.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD 14TH FLOOR, SUITE 14A CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $2K | $2K | 1.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 2393 TOWNSGATE ROAD, SUITE 101 WESTLAKE VILLAGE, CA 91361 | AFLAC | $3K | $0 | $3K | 6.45% |
| BRANDON TYLOR-DA SHIRLEY3 | 5110 SOUTH SHERBOURNE DRIVE LOD ANGELES, CA 90056 | AFLAC | $2K | $144 | $2K | 5.64% |
| CARLOS DAVID HERNANDEZ3 Filed as: CARLOS JESUS LOPEZ | 14025 JEFFERSON AVENUE HAWTHORNE, CA 90250 | AFLAC | $1K | $71 | $1K | 3.13% |
| DAVID HERNANDEZ3 | 2239 WEST 190TH STREET TORRANCE, CA 90504 | AFLAC | $863 | $65 | $928 | 2.18% |
| TALHA ZAQUIR RAHMAN3 | 10973 PRESCOTT DRIVE FRISCO, TX 75033 | AFLAC | $613 | $0 | $613 | 1.44% |
| MYKISHA L. THOMAS3 Filed as: MYKISHA BUTLER | 3886 3RD AVENUE LOS ANGELES, CA 90008 | AFLAC | $250 | $0 | $250 | 0.59% |
| SARAH ELLIN EDWARDS3 | 5211 PACIFIC CONCOURSE DRIVE APARTMENT 1254 LOS ANGELES, CA 90045 | AFLAC | $110 | $23 | $133 | 0.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | PO BOX 2158 RIVERSIDE, CA 92516 | VSP VISION CARE | $1K | $0 | $1K | 4.77% |
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 | 164 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 94 | $986K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 164 | $166K |
| Vision | VSP VISION CARE | 161 | $29K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 164 | $91K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 164 | $91K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 164 | $91K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 94 | $986K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 164 | $134K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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.