| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES,. INC. | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $129K | $23K | $153K | 4.12% |
| SPECTRA MANAGEMENT, LLC3 | 75 WEST TOWNE RIDGE PARKWAY SANDY, UT 84070 | LIFEMAP | $19K | $0 | $19K | 4.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALI | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $9K | $3K | $12K | 12.85% |
| JASON SEFITA FANAIKA3 | 1005 NORTH 900 EAST PLEASANT GROVE, UT 84062 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $763 | $4K | 19.99% |
| SPECTRA MANAGEMENT, LLC3 | 75 WEST TOWNE RIDGE PARKWAY SANDY, UT 84070 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 9.96% |
| CUSTOM INSURANCE SPECIALISTS INC3 Filed as: CUSTOM INSURANCE SPECIALISTS, INC. | 886 EAST 3200 NORTH KAMAS, UT 84036 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $285 | $2K | 9.65% |
| LESLEE BROOKE GOBELMAN3 | 5607 SOUTH GREENLEAF DRIVE MURRAY, UT 84123 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $173 | $2K | 8.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES,. INC. | PO BOX 2158 RIVERSIDE, CA 92516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 6.71% |
| SPECTRA MANAGEMENT, LLC3 | 75 WEST TOWNE RIDGE PARKWAY SANDY, UT 84070 | EYEMED VISION CARE | $4K | $0 | $4K | 21.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES,. INC. | PO BOX 2158 RIVERSIDE, CA 92516 | EYEMED VISION CARE | $957 | $0 | $957 | 5.41% |
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 | 100 | 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) | 100 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 32 | $3.8M |
| Dental | LIFEMAP | 951 | $464K |
| Vision | EYEMED VISION CARE | 420 | $18K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 100 | $91K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 100 | $91K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 100 | $91K |
| Prescription drug(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 32 | $3.8M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 100 | $112K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 951 | — |
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.