| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | UNKNOWN BREMERTON, WA 98337 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $59K | $0 | $59K | 5.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 3018 BOTHELL, WA 980413018 | UNION SECURITY INSURANCE COMPANY | $5K | $1K | $6K | 4.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NORTHEAST 195TH STREET SUITE 200 BOTHELL, WA 98011 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $1K | $13K | 12.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NE 195TH STREET, SUITE 200 BOTHELL, WA 98011 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $332 | $4K | 3.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NORTHEAST 195TH STREET SUITE 200 BOTHELL, WA 98011 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $192 | $5K | 15.56% |
| AON CONSULTING INC3 Filed as: BSWIFT | 10 SOUTH RIVERSIDE PLAZE SUITE 1100 CHICAGO, IL 60606 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 3.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 749083 LOS ANGELES, CA 90074 | VISION SERVICE PLAN | $944 | $0 | $944 | 6.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 12100 NORTHEAST 195TH STREET SUITE 200 BOTHELL, WA 98011 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $1K | $84 | $1K | 13.46% |
| AON CONSULTING INC3 Filed as: BSWIFT | 10 SOUTH RIVERSIDE PLAZE SUITE 1100 CHICAGO, IL 60606 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $310 | $0 | $310 | 3.01% |
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 | 130 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 132 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 140 | $1.1M |
| Dental | UNION SECURITY INSURANCE COMPANY | 142 | $115K |
| Vision | VISION SERVICE PLAN | 132 | $16K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 248 | $108K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 68 | $34K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 248 | $108K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 140 | $1.1M |
| Other(4 contracts, 4 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 248 | $153K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 248 | — |
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.