| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST | PO BOX 2158 RIVERSIDE, CA 92516 | PREMERA BLUE CROSS | $95K | $13K | $109K | 5.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NORTHEAST 195TH STREET SUITE 200 BOTHELL, WA 98011 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $40K | $0 | $40K | 19.03% |
| ENROLLMENT ALLIANCE LLC5 | 1724 EAST 5T AVENUE TAMPA, FL 33605 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $264 | $264 | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST | PO BOX 3018 BOTHELL, WA 98041 | VISION SERVICE PLAN | $882 | $0 | $882 | 5.29% |
| EMPLOYEE NAVIGATOR, LLC3 | 7979 OLD GEORGETOWN ROAD SUITE 300 BETHESDA, MD 20814 | VISION SERVICE PLAN | $86 | $0 | $86 | 0.52% |
| UNKNOWN3 | UNKNOWN SUMAS, WA 98295 | VISION SERVICE PLAN | -$100K | $0 | -$100K | -600.23% |
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 | 325 | 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) | 325 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREMERA BLUE CROSS | 292 | $2.1M |
| Dental | PREMERA BLUE CROSS | 292 | $2.1M |
| Vision | VISION SERVICE PLAN | 103 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 305 | $212K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 305 | $212K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 305 | $212K |
| Prescription drug | PREMERA BLUE CROSS | 292 | $2.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 305 | $212K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 305 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.