| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | 2000 SOUTH COLORADO BOULEVARD SUITE 150 DENVER, CO 80222 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $19K | $0 | $19K | 3.06% |
| IMA, INC.3 | 95 SOUTH STATE STREET, SUITE 1300 SALT LAKE CITY, UT 84111 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $12K | $0 | $12K | 1.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC | $9K | $0 | $9K | 2.78% |
| DIVERSIFIED INSURANCE GROUP3 | 95 SOUTH STATE STREET, SUITE 1300 SALT LAKE CITY, UT 84111 | KAISER FOUNDATION HEALTH PLAN, INC | $4K | $0 | $4K | 1.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | PO BOX 2158 RIVERSIDE, CO 92516 | USABLE LIFE | $7K | $0 | $7K | 8.94% |
| IMA, INC.3 | 1705 17TH STREET, SUITE 100 DENVER, CO 80202 | USABLE LIFE | $3K | $0 | $3K | 4.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | 111 SOUTH TEJON, SUITE 113 COLORADO SPRINGS, CO 80903 | HUMANA INSURANCE COMPANY | $2K | $0 | $2K | 5.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | HUMANA INSURANCE COMPANY | $0 | $2K | $2K | 4.06% |
| IMA, INC.3 | PO BOX 2992 WICHITA, KS 67201 | HUMANA INSURANCE COMPANY | $972 | $0 | $972 | 2.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES, INC | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $241 | $0 | $241 | 3.01% |
| IMA, INC.3 | PO BOX 733835 DALLAS, TX 75373 | VISION SERVICE PLAN | $159 | $0 | $159 | 1.99% |
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 | 100 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 96 | $927K |
| Dental(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 96 | $666K |
| Vision(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY | 39 | $55K |
| Life insurance | USABLE LIFE | 100 | $73K |
| Long-term disability | USABLE LIFE | 100 | $73K |
| Prescription drug(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 96 | $927K |
| Other | USABLE LIFE | 100 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 100 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.