| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $179K | $6K | $185K | 3.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 4047 CONCORD, CA 94524 | KAISER FOUNDATION HEALTH PLAN INC | $8K | $0 | $8K | 0.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL, INS. SVCES., INC | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | SUTTER HEALTH PLUS | $21K | $0 | $21K | 5.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL, INS. SVCES., INC | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | SUN LIFE ASSURANCE COMPANY OF CANADA | $20K | $9K | $29K | 17.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL, INS. SVCES., INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | STERLING LIFE INSURANCE COMPANY | $5K | $0 | $5K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL, INS. SVCES., INC | 1091 NORTH SHORELINE BOULEVARD SUITE 200 MOUNTAIN VIEW, CA 94043 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 5.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL, INS. SVCES., INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | WESTERN HEALTH ADVANTAGE | $3K | $0 | $3K | 4.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL, INS. SVCES., INC | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 27.02% |
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 | 1,317 | 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) | 1,317 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 610 | $5.3M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,083 | $163K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 999 | $88K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,083 | $163K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,083 | $163K |
| Prescription drug(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 610 | $5.3M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,083 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,083 | — |
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.