| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | HEALTH NET | $182K | $0 | $182K | 4.80% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRANO, CA 92675 | HEALTH NET | -$35 | $0 | -$35 | -0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 456 MONTGOMERY STREET, SUITE 1200 SAN FRANCISCO, CA 94104 | HUMANA INSURANCE COMPANY | $23K | $15K | $38K | 8.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $60K | $18K | $78K | 21.47% |
| WINSTON FINANCIAL SERVICES5 Filed as: WINSTON FINANCIAL SERVICES INC | 2399 HIGHWAY 34, BUILDING C2 MANASQUAN, NJ 08736 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $50K | $50K | 13.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.79% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 6B LIBERTY, SUITE 200 ALISO VIEJO, CA 92656 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.85% |
| JUND BRIAN EDWARD3 | 34 FALKNER DRIVE LADERA RANCH, CA 92694 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $27 | $0 | $27 | 0.02% |
| GRAVES ALEXIS3 | PO BOX 80324 CHARLESTON, SC 29416 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $25 | $0 | $25 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 3 EMBARCADERO CENTER, SUITE 460 SAN FRANCISCO, CA 94111 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $3K | $0 | $3K | 9.84% |
| ENERGI3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRANO, CA 92675 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 7.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $2K | $0 | $2K | 5.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | CALIFORNIA DENTAL NETWORK INC | $2K | $0 | $2K | 10.00% |
| ROBERT DEVALLE3 | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | LANDMARK HEALTHPLAN | $2K | $0 | $2K | 10.00% |
| EMPLOYERS NATL EXPERT RESOURCE GRP3 | 33302 VALLE ROAD, BUILDING B SUITE 250 SAN JUAN CAPISTRANO, CA 92675 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 19.43% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 1 NORTH WHITE HORSE PIKE, SUITE 2 HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $129 | $0 | $129 | 0.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 255387 SACRAMENTO, CA 95865 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $246 | $0 | $246 | 16.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $93 | $0 | $93 | 10.03% |
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 | 1,083 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 17 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NET | 638 | $3.8M |
| Dental(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 477 | $477K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 639 | $36K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,679 | $377K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,679 | $362K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,679 | $362K |
| Prescription drug | HEALTH NET | 629 | $3.8M |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,679 | $481K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,679 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.