| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $118K | $7K | $125K | 3.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | LIFEMAP ASSURANCE COMPANY | $39K | $0 | $39K | 6.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 75 WEST TOWNE RIDGE PARKWAY TOWER 2, SUITE 400 SANDY, UT 84070 | UPMC HEALTH OPTIONS | $4K | — | $4K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS. SVCS. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $202 | $202 | 0.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 2158 RIVERSIDE, CA 92516 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $7K | — | $7K | 13.89% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | PO BOX 2158 RIVERSIDE, CA 92516 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $6K | $0 | $6K | 13.95% |
| CUSTOM INSURANCE SPECIALISTS INC3 Filed as: CUSTOM INSURANCE SPECIALISTS INC. | 886 EAST 3200 NORTH KAMAS, UT 84036 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $738 | $122 | $860 | 13.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SERVICES | PO BOX 2158 RIVERSIDE, CA 92516 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $477 | $18 | $495 | 7.50% |
| LESLEE BROOKE GOBELMAN3 | 5607 SOUTH GREENLEAF DRIVE MURRAY, UT 84123 | COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | $223 | $32 | $255 | 3.86% |
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 | 174 | 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) | 174 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 803 | $3.5M |
| Dental | LIFEMAP ASSURANCE COMPANY | 172 | $599K |
| Vision(2 contracts) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 617 | $96K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 172 | $599K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 172 | $599K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 172 | $599K |
| Prescription drug(3 contracts, 3 carriers) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 803 | $3.5M |
| Other(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 172 | $606K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 803 | — |
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.