| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | P.O. BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $49K | — | $49K | 5.49% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GROUP, INC. | 5110 N. 40TH STREET, SUITE 234 PHOENIX, AZ 85018 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $19K | $19K | 2.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 4.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 4.96% |
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS-SEE ATTACHED | C/O AFLAC 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $9K | $430 | $9K | 14.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | HEALTH PLAN OF NEVADA | $2K | — | $2K | 4.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 1903 WRIGHT PLACE, SUITE 280 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $202 | $3K | 16.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 1903 WRIGHT PLACE, SUITE 280 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $152 | $3K | 15.92% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 1903 WRIGHT PLACE, SUITE 280 CARLSBAD, CA 92008 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $380 | $22 | $402 | 15.88% |
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 | 148 | 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) | 148 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 104 | $1.3M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 104 | $886K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 104 | $886K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 148 | $79K |
| Short-term disability | AFLAC | 56 | $63K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 36 | $20K |
| Prescription drug(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 104 | $1.3M |
| Other(2 contracts, 2 carriers) | AFLAC | 148 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 148 | — |
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.