| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 3135 ALBUQUERQUE, NM 871903135 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $969 | $969 | 0.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 6565 AMERICAS PKWY NE STE 720 ALBUQUERQUE, NM 87110 | UNITED CONCORDIA INSURANCE COMPANY | $3K | — | $3K | 9.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | PO BOX 2158 RIVERSIDE, CA 925162158 | VISION SERVICE PLAN | $762 | — | $762 | 7.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | SUN LIFE ASSURANCE COMPANY OF CANADA | $797 | — | $797 | 14.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HUB INTERNATIONAL INS SVCS INC BROKER | Insurance brokerage commissions and fees; Consulting (general); Insurance services; Other insurance fees and expenses; Insurance agents and brokers Service code 16 | PO BOX 3135 ALBUQUERQUE, NM 871903135 | $14K |
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 | 122 | 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) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 74 | $359K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 94 | $31K |
| Vision | VISION SERVICE PLAN | 74 | $10K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 122 | $7K |
| Other(2 contracts, 2 carriers) | PRESBYTERIAN HEALTHCARE SERVICES DBA THE SOLUTIONS GROUP | 122 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 122 | — |
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.