| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD, 11TH FLOOR SCHAUMBURG, IL 60173 | BLUE CROSS OF CALIFORNIA | $154K | — | $154K | 4.79% |
| LOCKTON COMPANIES, LLC3 | DEPARTMENT LA 23940 PASADENA, CA 91185 | BLUE CROSS OF CALIFORNIA | $14K | — | $14K | 0.44% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD, 11TH FLOOR SCHAUMBURG, IL 60173 | HEALTH PLAN OF NEVADA | $29K | — | $29K | 5.03% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD, 11TH FLOOR SCHAUMBURG, IL 60173 | AMERITAS LIFE INSURANCE CORPORATION | $7K | — | $7K | 7.43% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | AMERITAS LIFE INSURANCE CORPORATION | $2K | — | $2K | 2.57% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD, 11TH FLOOR SCHAUMBURG, IL 60173 | NATIONWIDE LIFE INSURANCE COMPANY | $5K | — | $5K | 8.93% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | NATIONWIDE LIFE INSURANCE COMPANY | $1K | — | $1K | 2.69% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD, 11TH FLOOR SCHAUMBURG, IL 60173 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $410 | $4K | 11.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3635 RIVERSIDE PLAZA DRIVE BUILDING M3, SUITE 320 RIVERSIDE, CA 92506 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $306 | $4K | 10.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE RIVERSIDE, CA 92501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $61 | $61 | 0.16% |
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 | 433 | 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) | 433 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 509 | $3.8M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 509 | $3.3M |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 509 | $3.3M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 509 | $3.3M |
| Short-term disability | NATIONWIDE LIFE INSURANCE COMPANY | 67 | $54K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 269 | $38K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 509 | $3.8M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 509 | $3.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 509 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.