| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $100K | $602 | $100K | 4.14% |
| INTERCARE INSURANCE SOLUTIONS, INC.3 | PO BOX 2158 RIVERSIDE, CA 92516 | BLUE CROSS OF CALIFORNIA | — | $2K | $2K | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | — | $15K | 10.15% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | DELTA DENTAL OF CALIFORNIA | $10K | — | $10K | 6.69% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | KAISER FOUNDATION HEALTH PLAN INC | — | $45 | $45 | 0.06% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 9868 PLANO ROAD DALLAS, TX 75238 | LIFESECURE INSURANCE COMPANY | $4K | — | $4K | 13.13% |
| THE HASLETT MANAGEMENT GROUP3 | 459 HERNDON PARKWAY HERNDON, VA 20170 | LIFESECURE INSURANCE COMPANY | $3K | — | $3K | 7.75% |
| DAVID HILLELSOHN3 | 459 HERNDON PARKWAY HERNDON, VA 20170 | LIFESECURE INSURANCE COMPANY | $2K | — | $2K | 5.19% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | 1100 REYNOLDS BOULEVARD WINSTON-SALEM, NC 27105 | LIFESECURE INSURANCE COMPANY | $1K | — | $1K | 3.09% |
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 | 176 | 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) | 176 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 490 | $2.5M |
| Dental | DELTA DENTAL OF CALIFORNIA | 472 | $145K |
| Vision | BLUE CROSS OF CALIFORNIA | 490 | $2.4M |
| Life insurance(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 490 | $2.6M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 176 | $152K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 176 | $152K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 490 | $2.5M |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 490 | $2.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 490 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.