| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $35K | $0 | $35K | 1.60% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING CO | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | $0 | $8K | 0.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $13K | $0 | $13K | 1.42% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING CO | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $7K | $0 | $7K | 0.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | $0 | $2K | 0.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $35K | $0 | $35K | 4.53% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $4K | $0 | $4K | 0.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 600 CORPORATE POINTE, SUITE 600 CULVER CITY, CA 90230 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $43K | $0 | $43K | 6.07% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | $0 | $10K | 1.43% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 0.55% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | CONTINENTAL AMERICAN INSURANCE COMPANY | $60K | $0 | $60K | 8.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $25K | $0 | $25K | 3.59% |
| USI INSURANCE SERVICES LLC3 | 1787 SENTRY PARKWAY WEST VEVA 16 BLUE BELL, ME 04106 | CONTINENTAL AMERICAN INSURANCE COMPANY | $4K | $0 | $4K | 0.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $11K | $0 | $11K | 1.80% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $1K | $0 | $1K | 0.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $2K | $0 | $2K | 1.39% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HOLDING CO | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $819 | $0 | $819 | 0.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $3K | $0 | $3K | 2.03% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTIC HOLDING COMPANY | PO BOX 62949 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $1K | $0 | $1K | 0.79% |
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 | 1,177 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 53 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 181 | $3.9M |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 2,369 | $782K |
| Vision | VISION SERVICE PLAN | 1,105 | $131K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,334 | $712K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,334 | $712K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,334 | $712K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 181 | $3.9M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,370 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,369 | — |
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."
No prospect flags tripped on this filing.