| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 255387 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN INC | $58K | $0 | $58K | 4.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $485 | $485 | 0.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 255387 SACRAMENTO, CA 95865 | SUTTER HEALTH PLAN | $27K | $0 | $27K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 16 EAST DEXTER PLAZA PEARL RIVER, NY 10965 | PREMIER ACCESS INSURANCE COMPANY | $3K | $0 | $3K | 2.67% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SVCS., LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | PREMIER ACCESS INSURANCE COMPANY | $2K | $0 | $2K | 1.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 255387 SACRAMENTO, CA 95865 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $11K | $984 | $12K | 15.61% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SVCS., LLC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94403 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$97 | $3K | $3K | 3.91% |
| T2B SOLUTIONS INC.3 Filed as: T2B SOLUTIONS INC | 1214 NORTH B STREET INDIANOLA, IA 50125 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $377 | $377 | 0.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $4K | $0 | $4K | 10.59% |
| EMPLOYEE NAVIGATOR, LLC3 | 7979 OLD GEORGETOWN ROAD SUITE 300 BETHESDA, MD 20814 | VISION SERVICE PLAN | $177 | $0 | $177 | 0.53% |
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 | 264 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 273 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 157 | $1.8M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 352 | $114K |
| Vision | VISION SERVICE PLAN | 230 | $33K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 264 | $74K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 264 | $74K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 157 | $1.8M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 264 | $74K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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.