| 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 OF THE NORTHWEST | $5K | $5 | $5K | 2.76% |
| THE LADD GROUP, LLC3 Filed as: THE LADD GROUP LLC | 1306 NORTHWEST HOYT STREET SUITE 404 PORTLAND, OR 97209 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | $0 | $2K | 1.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 749083 LOS ANGELES, CA 90074 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 8.76% |
| SUSAN M. DOMINION3 | 4333 NORTHEAST 30TH AVENUE PORTLAND, OR 97211 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 5.86% |
| SUSAN M. DOMINION3 | 3415 NORTH EAST BRYCE STREET PORTLAND, OR 97212 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $785 | $0 | $785 | 1.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 749083 LOS ANGELES, CA 90074 | KAISER FOUNDATION HEALTH PLAN INC | $1K | $0 | $1K | 2.81% |
| SUSAN DOMINION3 Filed as: SUSAN MARIE DOMINION | 1306 NW HOYT STREET, SUITE 404 POTLAND, OR 97209 | KAISER FOUNDATION HEALTH PLAN INC | $528 | $0 | $528 | 1.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 749083 LOS ANGELES, CA 90074 | VISION SERVICE PLAN | $942 | $0 | $942 | 4.67% |
| SUSAN DOMINION3 | 4333 NORTHEAST 30TH AVENUE PORTLAND, OR 97211 | VISION SERVICE PLAN | $181 | $0 | $181 | 0.90% |
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 | 126 | 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) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 28 | $213K |
| Vision | VISION SERVICE PLAN | 100 | $20K |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 126 | $62K |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 126 | $62K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 126 | $62K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 28 | $213K |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 126 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 126 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.