| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | NIPPON LIFE INSURANCE COMPANY OF AMERICA | $37K | — | $37K | 8.49% |
| INA NETWORK AMERICA3 | 1487 DAVID LANE BOISE, ID 83705 | NIPPON LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 1.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN INC. | $16K | $760 | $17K | 5.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | $294 | $6K | 4.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | PREMIER ACCESS INSURANCE COMPANY | $5K | — | $5K | 7.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $2K | — | $2K | 11.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $780 | $119 | $899 | 11.20% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD. SAN MATEO, CA 94403 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $390 | $390 | 4.86% |
| RYAN C ELLISON4 | 120 DEMURRAGE WAY FOLSOM, CA 95630 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $793 | — | $793 | 24.09% |
| ELIZABETH M RIEN4 | 1549 DISC DRIVE SPARKS, NV 89436 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $123 | — | $123 | 3.74% |
| CHRISTA G AUFDEMBERG INC4 | 13102 BRITTANY WOODS DR TUSTIN, CA 92780 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $93 | — | $93 | 2.83% |
| GABRIELE MARIA CEIDEBURG4 | 10181 LOOKOUT BRIDGE ST LAS VEGAS, NV 89183 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $31 | — | $31 | 0.94% |
| LISA L BASS3 | 8324 DUNMORE DR, APT C HUNTERVILLE, NC 28078 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $17 | — | $17 | 0.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $226 | — | $226 | 10.00% |
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 | 97 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 98 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | NIPPON LIFE INSURANCE COMPANY OF AMERICA | 76 | $895K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 83 | $68K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 54 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $23K |
| Short-term disability | AFLAC | 21 | $16K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $11K |
| Prescription drug(3 contracts, 2 carriers) | NIPPON LIFE INSURANCE COMPANY OF AMERICA | 76 | $895K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 96 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 96 | — |
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.