| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NE 195TH STREET, SUITE 200 BOTHELL, WA 98041 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $56K | $0 | $56K | 3.71% |
| BCI GROUP, INC.3 Filed as: BCI GROUP INC. | UNKNOWN PORTLAND, OR 97267 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | -$270 | $0 | -$270 | -0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | 12100 NE 195TH STREET, SUITE 200 BOTHELL, WA 98041 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $3K | $70 | $3K | 1.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHWEST LLC | PO BOX 749083 LOS ANGELES, WA 98041 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $22K | $0 | $22K | 14.73% |
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 | 241 | 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) | 241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 306 | $1.8M |
| Dental(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 306 | $1.8M |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 306 | $1.8M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $151K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $151K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $151K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 306 | $1.8M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 302 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 306 | — |
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.