| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCES | PO BOX 255387 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN INC | $53K | $0 | $53K | 4.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCES | PO BOX 255387 SACRAMENTO, CA 95865 | SUTTER HEALTH PLAN | $30K | $0 | $30K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICE INC | FRS UP 16 EAST DEXTER PLAZA PEARL RIVER, NY 10965 | PREMIER ACCESS INSURANCE COMPANY | $6K | $0 | $6K | 5.12% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES L | 2677 NORTH MAIN STREET SUITE 800 SANTA ANA, CA 92705 | PREMIER ACCESS INSURANCE COMPANY | $2K | $0 | $2K | 2.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCES | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | $5K | $20K | 19.68% |
| SHEALY BENEFITS SERVICES INC5 Filed as: SHEALY BENEFITS SERVICES | 215 HOGAN WAY LEXINGTON, SC 29072 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $15K | $15K | 14.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCES | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $3K | $0 | $3K | 9.98% |
| EMPLOYEE NAVIGATOR, LLC3 Filed as: EMPLOYEE NAVIGATOR LLC | 7979 OLD GEORGETOWN ROAD SUITE 300 BETHESDA, MD 20814 | VISION SERVICE PLAN | $163 | $0 | $163 | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCES | PO BOX 2158 RIVERSIDE, CA 92516 | MUTUAL OF OMAHA INSURANCE COMPANY | $860 | $243 | $1K | 19.24% |
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 | 254 | 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) | 254 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 146 | $1.7M |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 324 | $112K |
| Vision | VISION SERVICE PLAN | 210 | $33K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 254 | $100K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 254 | $100K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 146 | $1.7M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 254 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 324 | — |
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.