| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC. | $14K | $123 | $14K | 3.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNTAIONAL INS. SVCES., INC. | PO BOX 5076 SAN RAMON, CA 94583 | UNITED HEALTHCARE INSURANCE COMPANY | $17K | — | $17K | 5.00% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 Filed as: INTERCARE INSURANCE SOLUTIONS INC. | 5375 MIRA SORRENTO PLACE, SUITE 400 SAN DIEGO, CA 92121 | UNITED HEALTHCARE INSURANCE COMPANY | — | $2K | $2K | 0.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3000 EXECUTIVE PARKWAY, SUITE 300 SAN RAMON, CA 94583 | PREMIER ACCESS INSURANCE COMPANY | $3K | — | $3K | 3.84% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 2300 CLAYTON ROAD, SUITE 300 CONCORD, CA 94520 | MESVISION | $984 | — | $984 | 10.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3000 EXECUTIVE PARKWAY, SUITE 300 SAN RAMON, CA 94583 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $490 | $205 | $695 | 19.40% |
| UNKNOWN3 | UNKNOWN CONCORD, CA 94520 | HOLMAN FAMILY COUNSELING, INC. | $96 | — | $96 | 4.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3000 EXECUTIVE PARKWAY, SUITE 300 SAN RAMON, CA 94583 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $174 | $36 | $210 | 12.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB - CA CONCORD | 2300 CLAYTON RD., SUITE 300 CONCORD, CA 94520 | HOLMAN FAMILY COUNSELING, INC. | $24 | — | $24 | 5.70% |
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 | 134 | 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) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 80 | $706K |
| Dental | PREMIER ACCESS INSURANCE COMPANY | 156 | $86K |
| Vision | MESVISION | 59 | $9K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 117 | $5K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 80 | $706K |
| Other(3 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 117 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.