| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 3310 SANTA BARBARA, CA 93130 | BLUE CROSS OF CALIFORNIA | $0 | $3K | $3K | 0.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $966 | $966 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $946 | $946 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | 3636 AMRICAN RIVER DRIVE, SUITE 200 SACRAMENTO, CA 95864 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $3K | $3K | 4.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 EAST JACKSON, 12TH FLOOR CHICAGO, IL 60604 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.08% |
| HELEN LOUISE LUDVIGSON4 | 3405 NW 112ND STREET VANCOUVER, WA 98685 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $374 | $0 | $374 | 16.44% |
| DONNA S. KRAMER4 | 4815 HOLDEN DRIVE ROCKLIN, CA 95677 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $38 | $0 | $38 | 1.67% |
| MARICA SCHWARTZ4 | 312 VIA PROMESA SAN CLEMENTE, CA 92673 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $31 | $0 | $31 | 1.36% |
| ADAM LUDVIGSON4 | 3405 NW 122ND STREET VANCOUVER, WA 98685 | PRE-PAID LEGAL SERVICES, INC DBA LEGALSHIELD | $29 | $0 | $29 | 1.27% |
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 | 175 | 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) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 199 | $2.8M |
| Vision | VISION SERVICE PLAN | 152 | $37K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 175 | $64K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $51K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 175 | $51K |
| Prescription drug(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 199 | $2.8M |
| Other(5 contracts, 5 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 190 | $122K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.