| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | KAISER FOUNDATION HEALTH PLANS INC. | $38K | $1K | $39K | 1.43% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | CALIFORNIA PHYSICIANS SERVICE | $81K | $13K | $94K | 5.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | KAISER FOUNDATION HEALTH PLANS INC. | $15K | $470 | $16K | 1.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | DELTA DENTAL OF CALIFORNIA | $20K | — | $20K | 4.98% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP NATIONAL ACCOUNT SVCS INC | DEPT 2075, PO BOX 29675 PHOENIX, AZ 85038 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 9.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | EYEMED VISION CARE | $7K | — | $7K | 8.68% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 4.61% |
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 | 917 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 924 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS INC. | 519 | $5.5M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 483 | $476K |
| Vision | EYEMED VISION CARE | 1,210 | $80K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 917 | $102K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 917 | $102K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS INC. | 519 | $5.5M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 917 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,210 | — |
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.