| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | BLUE CROSS OF CALIFORNIA | $79K | — | $79K | 4.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVS INC | 4371 LATHAM ST #101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SERVICES INC | 3390 UNIVERSITY AVE SUITE 300 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | — | $356 | $356 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | KAISER FOUNDATION HEALTH PLAN INC | $48K | — | $48K | 4.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 606930001 | VISION SERVICE PLAN | $2K | — | $2K | 4.01% |
| ASSURANCE AGENCY LTD3 | 1750 E GOLF RD 11TH FL SCHAUMBURG, IL 60173 | AMERICAN FIDELITY ASSURANCE COMPANY | $764 | — | $764 | 2.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | AMERICAN FIDELITY ASSURANCE COMPANY | $50 | — | $50 | 0.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD | 55 EAST JACKSON BOULEVARD CHICAGO, IL 60604 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $1K | $4K | 25.00% |
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 | 396 | 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) | 396 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 206 | $2.7M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 278 | $18K |
| Vision | VISION SERVICE PLAN | 226 | $38K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 206 | $1.6M |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 78 | $29K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 78 | $29K |
| Other | AMERICAN FIDELITY ASSURANCE COMPANY | 78 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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.