| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $694 | $0 | $694 | 1.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $991 | $991 | 1.78% |
| HELEN LOUISE LUDVIGSON4 | 3405 NORTHWEST 122ND STREET VANCOUVER, WA 98685 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $226 | $0 | $226 | 14.11% |
| MARIA SCHWARTZ4 | 312 VIA PROMESA SAN CLEMENTE, CA 92673 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $33 | $0 | $33 | 2.06% |
| ADAM LUDVIGSON4 | 3405 NW 122ND STREET VANCOUVER, WA 98685 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $31 | $0 | $31 | 1.94% |
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 | 190 | 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) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 206 | $2.5M |
| Dental | DELTA DENTAL OF CALIFORNIA | 435 | $225K |
| Vision | VISION SERVICE PLAN | 180 | $39K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 188 | $62K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $56K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 190 | $56K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 206 | $2.5M |
| Other(5 contracts, 5 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 190 | $124K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 435 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.