| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $55K | $346 | $55K | 3.72% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $5K | $5K | $11K | 0.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN INC | $31K | — | $31K | 2.63% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 0.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 6.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $367 | $2K | 4.29% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | VISION SERVICE PLAN | $714 | — | $714 | 2.68% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $593 | — | $593 | 2.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $239 | $1K | 6.16% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 6.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $746 | $189 | $935 | 4.21% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $567 | $31 | $598 | 3.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $185 | — | $185 | 1.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $516 | $36 | $552 | 6.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $369 | — | $369 | 6.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $186 | $52 | $238 | 4.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON ROAD, SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $300 | — | $300 | 9.97% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $151 | $31 | $182 | 6.05% |
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 | 443 | 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) | 450 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 353 | $2.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 353 | $1.5M |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 353 | $1.5M |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 443 | $46K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 16 | $9K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 442 | $39K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 353 | $2.7M |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 443 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 443 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.