| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $12K | $12K | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST | 55 EAST JACKSON, 12FLOOR CHICAGO, IL 60604 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $0 | $133K | $133K | 3.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | 2000 SOUTH COLORADO BOULEVARD TOWER 2, SUITE 150 DENVER, CO 80222 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $0 | $37K | $37K | 1.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 844663 DALLAS, TX 75284 | VISION SERVICE PLAN | -$20K | $0 | -$20K | -2.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 1125 17TH STREET, SUITE 900 DENVER, CO 80202 | RELIASTAR LIFE INSURANCE COMPANY | $111K | $0 | $111K | 22.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 EAST JACKSON BOULEVARD SUITE 14A CHICAGO, IL 60604 | RELIASTAR LIFE INSURANCE COMPANY | $15K | $0 | $15K | 2.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $119 | $0 | $119 | 4.00% |
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 | 4,118 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 914 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 40 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,072 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,390 | $8.0M |
| Vision | VISION SERVICE PLAN | 3,122 | $708K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 4,998 | $3.7M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 4,998 | $3.7M |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,390 | $7.9M |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 4,130 | $578K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,998 | — |
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."
No prospect flags tripped on this filing.