| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVS., INC. | PO BOX 2158 RIVERSIDE, CA 92506 | HEALTH NET | $40K | $0 | $40K | 1.72% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | HEALTH NET | $6K | $0 | $6K | 0.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | 456 MONTGOMERY STREET, SUITE 1200 SAN FRANCISCO, CA 94104 | HUMANA INSURANCE COMPANY | $12K | $0 | $12K | 4.90% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | HUMANA INSURANCE COMPANY | $60 | $0 | $60 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $14K | $0 | $14K | 20.62% |
| HODGES-MACE LLC5 | 5775-D GLENRIDGE DRIVE NE SUITE 350 ATLANTA, GA 30328 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $10K | $10K | 14.27% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $6K | $0 | $6K | 11.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVS., INC. | PO BOX 2158 RIVERSIDE, CA 92506 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $309 | $0 | $309 | 0.65% |
| JUND BRIAN EDWARD3 | 99 WOOD AVENUE SOUTH, SUITE 390 ISELIN, NJ 08830 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $143 | $0 | $143 | 0.30% |
| WOLFF GUY3 | PO BOX 80324 CHARLESTON, SC 29416 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $71 | $0 | $71 | 0.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 255387 SACRAMENTO, CA 95865 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $0 | $4K | 10.33% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 4.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $1K | $1K | 2.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL SAN FRANCISICO CA | 3 EMBARCADERO CENTER, SUITE 460 SAN FRANCISCO, CA 94111 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 5.55% |
| ENERGI3 Filed as: ENERGI - BOR | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $1K | $0 | $1K | 5.52% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $7K | $0 | $7K | 65.32% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $51 | $0 | $51 | 0.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 5345 RIVERSIDE, CA 92517 | CALIFORNIA DENTAL NETWORK INC | $858 | $0 | $858 | 10.00% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRA, CA 92675 | VISION SERVICE PLAN | $60 | $0 | $60 | 9.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVS., INC. | PO BOX 2158 RIVERSIDE, CA 92506 | VISION SERVICE PLAN | $16 | $0 | $16 | 2.56% |
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 | 1,015 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 8 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,023 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 562 | $2.3M |
| Dental(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 358 | $253K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 633 | $23K |
| Life insurance(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,016 | $119K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,016 | $70K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,016 | $70K |
| Prescription drug | HEALTH NET | 562 | $2.3M |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,016 | $167K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,016 | — |
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.