| 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 | CALIFORNIA PHYSICIANS SERVICE | $74K | — | $74K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $26K | $203 | $26K | 5.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 90045 | DELTA DENTAL OF CALIFORNIA | $10K | — | $10K | 5.03% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 5405 MOREHOUSE DRIVE, SUITE 340 SAN DIEGO, CA 92121 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | $4K | $12K | 15.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | VISION SERVICE PLAN | $1K | — | $1K | 4.61% |
| ANGEL L. STEPHENS4 | PO BOX 36114 LOS ANGELES, CA 90036 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $486 | — | $486 | 10.78% |
| IBRAHIM ABDELHADI4 | 4510 WEST GUADALUPE STREET APARTMENT C412 AUSTIN, TX 78751 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $287 | — | $287 | 6.36% |
| JERRY K. COHEN4 | 15720 VENTURA BOULEVARD, SUITE 324 ENCINO, CA 91436 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $104 | — | $104 | 2.31% |
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 | 234 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 235 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 251 | $2.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 376 | $208K |
| Vision | VISION SERVICE PLAN | 228 | $31K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 234 | $82K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 234 | $82K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 251 | $2.0M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 234 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 376 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.