| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | PO BOX 2158 RIVERSIDE, CA 92516 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | -$53 | $2K | $1K | 0.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1591 GALBRAITH AVE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | — | $7K | $7K | 3.82% |
| JAMES A SCOTT & SON INC3 | 1301 OLD GRAVES MILL RD LYNCHBURG, VA 24502 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 1.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 1.34% |
| WATCHTOWER BENEFITS, LLC3 Filed as: WATCHTOWER BENEFITS LLC | 227 W MONROE ST STE 5200 CHICAGO, IL 60606 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 1.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 970 RESERVE DR STE 200 ROSEVILLE, CA 95678 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 0.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC | $31 | — | $31 | 0.39% |
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 | 538 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 542 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 2 | $8K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 492 | $415K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 492 | $415K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 883 | $185K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 883 | $185K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 883 | $185K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 2 | $8K |
| Other | HARTFORD LIFE AND ACCIDENT | 883 | $185K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 883 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.