| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $142K | $3K | $144K | 4.07% |
| WELLS FARGO INSURANCE SERVICES3 | 45 FREMONT STREET, 8TH FLOOR SAN FRANCISCO, CA 94105 | BLUE CROSS OF CALIFORNIA | -$183 | — | -$183 | -0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIOANL INS. SVCES., INC. | PO BOX 4047 CONCORD, CA 94524 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | — | $12K | 4.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIOANL INS. SVCES., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 1.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 39 MOUNTAIN VIEW, CA 94042 | VISION SERVICE PLAN | $1K | — | $1K | 4.78% |
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 | 200 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 415 | $3.5M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 428 | $251K |
| Vision | VISION SERVICE PLAN | 194 | $28K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 415 | $3.5M |
| Short-term disability | BLUE CROSS OF CALIFORNIA | 415 | $3.5M |
| Long-term disability | BLUE CROSS OF CALIFORNIA | 415 | $3.5M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 415 | $3.5M |
| Other | BLUE CROSS OF CALIFORNIA | 415 | $3.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 428 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.