| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVEWRSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $31K | $1K | $32K | 3.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | UNKNOWN SONOMA, CA 95476 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | $0 | $12K | 11.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | P.O. BOX 2158 RIVERSIDE, CA 92516 | UNION SECURITY INSURANCE COMPANY | $4K | $0 | $4K | 7.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4695 MACARTHUR COURT SUITE 600 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC | $629 | $0 | $629 | 2.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 55 EAST JACKSON, SUITE 14B CHICAGO, IL 60604 | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $144 | $144 | 1.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES, INC. | 3 EMBARCADERO CENTER SUITE 460 SAN FRANCISCO, CA 94111 | EYEMED VISION CARE | $957 | $0 | $957 | 9.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | P.O. BOX 2158 RIVERSIDE, CA 92516 | AMERICAN HERITAGE LIFE INSURANCE CO | $840 | $0 | $840 | 17.83% |
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 | 262 | 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) | 262 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 119 | $953K |
| Dental | UNION SECURITY INSURANCE COMPANY | 133 | $57K |
| Vision | EYEMED VISION CARE | 130 | $10K |
| Life insurance | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 207 | $13K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 207 | $13K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 119 | $848K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY | 207 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 207 | — |
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.