| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE SHIELD OF CALIFORNIA | $0 | $2K | $2K | 0.03% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | PO BOX 749140 ATLANTA, GA 30374 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $153 | $11K | 14.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $132 | $5K | 6.36% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 300 NORTH BEACH STREET DAYTONA BEACH, FL 32114 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $564 | $564 | 0.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HIB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $432 | $432 | 0.56% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN LONE STAR INS. SVCS. | 5850 GRANITE PARKWAY, SUITE 350 PLANO, TX 75024 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $39 | $39 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $291 | $0 | $291 | 0.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92502 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $9 | $0 | $9 | 0.02% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 3635 RIVERSIDE PLAZA DRIVE BUILDING M3, SUITE 320 RIVERSIDE, CA 92506 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | $9 | $0 | $9 | 0.02% |
| REUBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | HARTFORD LIFE AND ACCIDENT | $0 | $84 | $84 | 16.97% |
| BROWN & BROWN INSURANCE SERVICES3 Filed as: BROWN & BROWN INSURANCE SVCS., INC. | 2321 ROSECRANS AVENUE, SUITE 2240 EL SEGUNDO, CA 90245 | HARTFORD LIFE AND ACCIDENT | $74 | $0 | $74 | 14.95% |
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 | 706 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 717 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 578 | $10.8M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,029 | $483K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. | 864 | $53K |
| Life insurance | STANDARD INSURANCE COMPANY | 706 | $249K |
| Long-term disability | STANDARD INSURANCE COMPANY | 706 | $249K |
| Prescription drug(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 578 | $10.8M |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 706 | $327K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,029 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.