| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS. INC. | PO BOX 4047 CONCORD, CA 94524 | KAISER FOUNDATION HEALTH PLAN INC | $45K | $0 | $45K | 5.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCES. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $822 | $822 | 0.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS. INC. | 3000 EXECUTIVE PARKWAY, SUITE 300 SAN RAMON, CA 94583 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | $490 | $13K | 6.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS. INC. | 3000 EXECUTIVE PARKWAY, SUITE 300 SAN RAMON, CA 94583 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $0 | $5K | 5.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | HARTFORD LIFE AND ACCIDENT | $3K | $0 | $3K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVIES | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | $0 | $660 | $660 | 2.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON, SUITE 14B CHICAGO, IL 60604 | HARTFORD LIFE AND ACCIDENT | $0 | $219 | $219 | 0.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS. INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $666 | $0 | $666 | 3.00% |
| DANIEL OWEN MACLELLAN3 Filed as: DANIEL O. MACLELLAN | 515 WEST HILLWOOD DRIVE NASHVILLE, TN 37205 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 13.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS. INC. | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $99 | $1K | 7.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 3 EMBARCADERO CENTER, SUITE 460 SAN FRANCISCO, CA 94111 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 10.01% |
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 | 270 | 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) | 270 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 117 | $1.1M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $98K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 150 | $13K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 270 | $26K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 270 | $26K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 117 | $1.1M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 270 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.