| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | UNITEDHEALTHCARE INSURANCE COMPANY | $26K | $0 | $26K | 1.41% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 380 TORRANCE, CA 90503 | UNITEDHEALTHCARE INSURANCE COMPANY | $17K | $0 | $17K | 0.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | $188 | $11K | 1.49% |
| USI INSURANCE SERVICES LLC3 | 21250 HAWTHORNE BOULEVARD SUITE 380 TORRANCE, CA 90503 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $258 | $7K | 0.93% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $395 | $395 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $2 | $12K | 2.29% |
| USI INSURANCE SERVICES LLC3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $4K | $0 | $4K | 0.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | METLIFE LEGAL PLANS | $3K | $0 | $3K | 18.53% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $714 | $110 | $824 | 5.32% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | METLIFE LEGAL PLANS | $0 | $59 | $59 | 0.38% |
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 | 998 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,011 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,807 | $2.4M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 1,807 | $1.8M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 1,807 | $1.8M |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,515 | $706K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,515 | $706K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 1,515 | $706K |
| Prescription drug(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,807 | $2.4M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,515 | $722K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,807 | — |
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.