| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIOAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $29K | $0 | $29K | 4.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE SHIELD OF CALIFORNIA | $31K | $4K | $34K | 5.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVENUE RIVERSIDE, CA 92501 | AETNA LIFE INSURANCE COMPANY | $14K | $0 | $14K | 16.81% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WEST LAKE VILLAGE, CA 91361 | AETNA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 2.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 600 CORPORATE PONTE, SUITE 600 CULVER CITY, CA 90230 | HARTFORD LIFE AND ACCIDENT | $4K | $0 | $4K | 14.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | $0 | $733 | $733 | 2.73% |
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 | 158 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 88 | $1.3M |
| Dental | AETNA LIFE INSURANCE COMPANY | 174 | $83K |
| Vision | AETNA LIFE INSURANCE COMPANY | 174 | $83K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 158 | $27K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 88 | $1.3M |
| Other | HARTFORD LIFE AND ACCIDENT | 158 | $27K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
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.