| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 | 2120 PEWAUKEE RD SUITE 202 WAUKESHA, WI 53188 | BLUE CROSS OF CALIFORNIA | $91K | — | $91K | 4.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVS INC | PO BOX 3310 SANTA BARBARA, CA 93130 | BLUE CROSS OF CALIFORNIA | — | $2K | $2K | 0.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | KAISER FOUNDATION HEALTH PLAN INC | $47K | — | $47K | 4.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 15162 COLLECTION CENTER DR CHICAGO, IL 606930001 | VISION SERVICE PLAN | $2K | — | $2K | 5.66% |
| ASSURANCE AGENCY LTD3 | 1750 E GOLF RD 11TH FL SCHAUMBURG, IL 60173 | AMERICAN FIDELITY ASSURANCE COMPANY | $237 | — | $237 | 2.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD #14A CHICAGO, IL 60604 | AMERICAN FIDELITY ASSURANCE COMPANY | $17 | — | $17 | 0.16% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE AND HEALTH EIN 95-4331852 CONTRACT ADMINISTRATOR | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Claims processing Service code 12 | — | $16K |
| HUB INTERNATIONAL INS SRVS INC. EIN 33-0315047 BROKER | Insurance agents and brokers; Non-monetary compensation; Other commissions Service code 22 | — | $0 |
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 | 366 | 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) | 366 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 366 | $3.0M |
| Vision | VISION SERVICE PLAN | 247 | $38K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 366 | $2.1M |
| Short-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 37 | $11K |
| Long-term disability | AMERICAN FIDELITY ASSURANCE COMPANY | 37 | $11K |
| Other | AMERICAN FIDELITY ASSURANCE COMPANY | 37 | $11K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 366 | — |
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.