| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $13K | $0 | $13K | 7.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNTAIONAL OF CA INS. SVCS. | PO BOX 255387 SACRAMENTO, CA 95865 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | — | $5K | 2.75% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $0 | $7K | 8.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | PO BOX 255387 SACRAMENTO, CA 95865 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $882 | $0 | $882 | 0.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $752 | $0 | $752 | 2.52% |
| USI INSURANCE SERVICES LLC3 | PO BOX 39000 SAN FRANCISCO, CA 94139 | VISION SERVICE PLAN | $263 | $0 | $263 | 0.88% |
| USI INSURANCE SERVICES LLC3 | 1039A NORTH MCDOWELL BOUELVARD PETALUMA, CA 94954 | VISION SERVICE PLAN | $215 | $0 | $215 | 0.72% |
| USI INSURANCE SERVICES LLC3 | 1039A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | CLAREMONT EAP | $171 | $0 | $171 | 2.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 16253 COLLECTION CENTER CHICAGO, IL 60693 | CLAREMONT EAP | $126 | $0 | $126 | 2.02% |
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 | 146 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 159 | $187K |
| Vision | VISION SERVICE PLAN | 157 | $30K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 146 | $90K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 146 | $90K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 146 | $90K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 146 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 159 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.