| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DR STE 200 ROSEVILLE, CA 95678 | SUTTER HEALTH PLAN | $18K | — | $18K | 5.00% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | SUTTER HEALTH PLAN | $7K | — | $7K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 5.14% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 2.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DR STE 200 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN INC. | $578 | — | $578 | 0.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 701 UNIVERSITY AVE STE 100 SACRAMENTO, CA 95825 | WESTERN HEALTH ADVANTAGE | $11K | — | $11K | 7.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 203 N LA SALLE ST FL 20 CHICAGO, IL 60601 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $19 | $19 | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $799 | — | $799 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 203 N LA SALLE ST FL 20 CHICAGO, IL 60601 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $10 | $10 | 0.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | VISION SERVICE PLAN | $779 | — | $779 | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | PO BOX 2158 RIVERSIDE, CA 92516 | DELTACARE | $573 | — | $573 | 10.01% |
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 | 195 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | SUTTER HEALTH PLAN | 62 | $694K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 56 | $53K |
| Vision | VISION SERVICE PLAN | 52 | $8K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $24K |
| Prescription drug(3 contracts, 3 carriers) | SUTTER HEALTH PLAN | 62 | $694K |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.