| 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 | $31K | — | $31K | 3.58% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | BLUE CROSS OF CALIFORNIA | $17K | — | $17K | 1.93% |
| 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. | $21K | $786 | $22K | 3.78% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 1.96% |
| 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 | $5K | $21K | 9.70% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 3.93% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13K | $1K | $14K | 23.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | VISION SERVICE PLAN | $889 | — | $889 | 3.09% |
| LARRY J. BURDT3 | 4275 EXECUTIVE SQUARE, SUITE 400 LA JOLLA, CA 92037 | VISION SERVICE PLAN | $479 | — | $479 | 1.67% |
| 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 | $639 | $105 | $744 | 3.45% |
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 | 193 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 132 | $1.5M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 193 | $221K |
| Vision | VISION SERVICE PLAN | 172 | $29K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 193 | $221K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 193 | $221K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 132 | $1.5M |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 193 | $281K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 193 | — |
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.