| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | BLUE CROSS OF CALIFORNIA | $32K | $1K | $34K | 4.37% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | BLUE CROSS OF CALIFORNIA | $17K | — | $17K | 2.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 3.03% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 1.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | PRINCIPAL LIFE INSURANCE COMPANY | $16K | $7K | $24K | 11.11% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 4.12% |
| ROLAND PAUL LAMONTAGNE3 | 6507 PACIFIC AVENUE, SUITE 296 STOCKTON, CA 95207 | PRINCIPAL LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7K | $1K | $9K | 22.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | VISION SERVICE PLAN | $856 | — | $856 | 3.17% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | VISION SERVICE PLAN | $461 | — | $461 | 1.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $560 | — | $560 | 2.75% |
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 | 175 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 118 | $1.3M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 175 | $213K |
| Vision | VISION SERVICE PLAN | 151 | $27K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 175 | $213K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 175 | $213K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 118 | $1.3M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 175 | $252K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 175 | — |
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.