| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $56K | $0 | $56K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 600 CORPORATE POINTE CULVER CITY, CA 90230 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $72K | $0 | $72K | 6.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $15K | $15K | 1.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $22K | $0 | $22K | 2.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 600 CORPORATE POINTE, SUITE 600 CULVER CITY, CA 90230 | METROPOLITAN LIFE INSURANCE COMPANY | $90K | $44 | $90K | 9.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $9K | $9K | 0.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $14K | $0 | $14K | 1.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $4K | $0 | $4K | 1.81% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING CO. | PO BOX 62949 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $0 | $34 | $34 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $3K | $0 | $3K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12K | $0 | $12K | 11.42% |
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 | 1,437 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 44 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,493 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 307 | $4.9M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 2,492 | $982K |
| Vision | VISION SERVICE PLAN | 1,160 | $169K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,437 | $1.1M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,437 | $1.1M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,437 | $1.1M |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 307 | $4.9M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,437 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,492 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.