| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $51K | $1 | $51K | 3.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | UNITEDHEALTHCARE INSURANCE COMPANY | $13K | $0 | $13K | 5.28% |
| FNA INSURANCE SERVICES INC3 | 401 BROADHOLLOW ROAD, SUITE 303 MELVILLE, NY 11747 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $3K | $3K | 1.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | HARTFORD LIFE AND ACCIDENT | $11K | $0 | $11K | 17.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1591 GALBRAITH AVENUE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | $0 | $2K | $2K | 3.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 970 RESEARVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | $0 | $661 | $661 | 1.08% |
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 | 191 | 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) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 198 | $1.7M |
| Dental(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 198 | $1.7M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 43 | $240K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 108 | $61K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 198 | $1.7M |
| Other | HARTFORD LIFE AND ACCIDENT | 108 | $61K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 198 | — |
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.