| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | INSURANCE SERVICES INC 4371 LATHAM ST #101 RIVERSIDE, CA 92501 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $216K | $5K | $221K | 4.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | INSURANCE SERVICES PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | $123K | $4K | $127K | 4.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | INSURANCE SERVICES PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLAN INC | $39K | $2K | $41K | 4.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATONAL INSURANCE SERVICES | INC PO BOX 2158 RIVERSIDE, CA 925162158 | METROPLOITAN LIFE INSURANCE COMPANY | $71K | $54 | $71K | 12.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATONAL INSURANCE SERVICES | INC PO BOX 2158 RIVERSIDE, CA 925162158 | METROPLOITAN LIFE INSURANCE COMPANY | — | $4K | $4K | 0.62% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | — | VISION SERVICE PLAN | $16K | — | $16K | 9.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATONAL INSURANCE SERVICES | INC PO BOX 2158 RIVERSIDE, CA 925162158 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $10K | $522 | $11K | 12.90% |
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 | 1,966 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,004 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 538 | $9.0M |
| Dental(2 contracts, 2 carriers) | METROPLOITAN LIFE INSURANCE COMPANY | 1,022 | $652K |
| Vision | VISION SERVICE PLAN | 829 | $172K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 487 | $5.1M |
| Short-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 487 | $5.1M |
| Long-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 487 | $5.1M |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 487 | $5.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,022 | — |
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."
No prospect flags tripped on this filing.