| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | CALIFORNIA PHYSICIANS' SERVICE | $31K | $0 | $31K | 3.27% |
| WITH GUSTO INSURANCE SERVICE LLC3 Filed as: WITH GUSTO INS. AGENCY, LLC | 525 20TH STREET SAN FRANCISCO, CA 94107 | CALIFORNIA PHYSICIANS' SERVICE | $16K | $0 | $16K | 1.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | $0 | $9K | 2.27% |
| ZP INSURANCE LLC3 | 525 20TH STREET SAN FRANCISCO, CA 94107 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | $0 | $4K | 1.04% |
| ZP INSURANCE LLC3 | 500 3RD STREET, SUITE 405 SAN FRANCISCO, CA 94107 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $6K | $8K | 4.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 255387 SACRAMENTO, CA 95865 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 1.57% |
| ENROLLEASE3 | 660 YORK STREET, SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 2300 CLAYTON ROAD, SUITE 300 CONCORD, CA 94520 | PRINCIPAL LIFE INSURANCE COMPANY | $636 | $0 | $636 | 5.88% |
| WITH GUSTO INSURANCE SERVICE LLC3 Filed as: WITH GUSTO INS. AGENCY, LLC | 525 20TH STREET SAN FRANCISCO, IL 94107 | PRINCIPAL LIFE INSURANCE COMPANY | $355 | $81 | $436 | 4.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 150 NORTH RIVERSIDE PLAZA SUITE 1700 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $224 | $224 | 2.07% |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 180 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 66 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 144 | $200K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 144 | $200K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 162 | $11K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 66 | $1.3M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 162 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.