| 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 | BLUE CROSS OF CALIFORNIA | $76K | $4K | $81K | 5.26% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 NORTH MAIN STREET SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | $0 | $30K | $30K | 1.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN, INC. | $24K | $0 | $24K | 4.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTENATIONAL INS. SVCS., INC. | 3636 AMERICAN RIVER DRIVE SUITE 200 SACRAMENTO, CA 95864 | PRINCIPAL LIFE INSURANCE COMPANY | $16K | $0 | $16K | 5.59% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2 ENTERPRISE DRIVE, SUITE 204 SHELTON, CT 06484 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $12K | $12K | 4.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL LIMITED | 150 NORTH RIVERSIDE PLAZA SUITE 1700 CHICAGO, IL 60606 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $9K | $9K | 3.18% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $318 | $318 | 0.11% |
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 | 207 | 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) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 246 | $2.0M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 402 | $283K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 402 | $283K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 402 | $283K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 402 | $283K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 402 | $283K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 246 | $2.0M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 402 | $283K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 402 | — |
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.