| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NE 195TH STREET BOTHELL, WA 98011 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $21K | — | $21K | 2.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NE 195TH STREET BOTHELL, WA 98011 | DELTA DENTAL OF WASHINGTON | $2K | — | $2K | 2.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NE 195TH STREET BOTHELL, WA 98011 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $1K | — | $1K | 2.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | P.O. BOX 3018 BOTHELL, WA 98041 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $501 | — | $501 | 0.81% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $254 | — | $254 | 0.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | P.O. BOX 3018 BOTHELL, WA 98041 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 11.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | P.O. BOX 3018 BOTHELL, WA 98041 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 11.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | P.O. BOX 3018 BOTHELL, WA 98041 | VISION SERVICE PLAN | $778 | — | $778 | 6.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | P.O. BOX 3018 BOTHELL, WA 98041 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $296 | — | $296 | 11.24% |
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 | 122 | 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) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 85 | $1.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 107 | $101K |
| Vision | VISION SERVICE PLAN | 73 | $12K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 122 | $40K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 122 | $31K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 85 | $1.1M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 122 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 122 | — |
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.