| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $17K | — | $17K | 3.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 1.99% |
| AMWINS3 Filed as: AMWINS CONNECT INS SERVICES LLC GA | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 1.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92506 | HEALTH NET | $15K | $371 | $15K | 6.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 3390 UNIVERSITY AVE STE 300 RIVERSIDE, CA 92501 | MEDIEXCEL HEALTH PLAN | $5K | — | $5K | 4.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | PO BOX 2158 RIVERSIDE, CA 92516 | PRINCIPAL LIFE INSURANCE COMPANY | $9K | — | $9K | 12.66% |
| GIS BENEFITS INC3 | 422 WAUPONSEE ST MORRIS, IL 60450 | PRINCIPAL LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 150 N RIVERSIDE PLZ STE 1700 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | — | $3K | $3K | 4.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $467 | $217 | $684 | 15.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED CONCORDIA INSURANCE COMPANY | $647 | $323 | $970 | 54.65% |
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 | 103 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 70 | $840K |
| Dental(4 contracts, 4 carriers) | HEALTH NET | 104 | $317K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 104 | $311K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 104 | $69K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 104 | $69K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 70 | $598K |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 104 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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.