| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | KAISER FOUNDATION HEALTH PLAN INC. | $81K | $2K | $83K | 5.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | SHARP HEALTH PLAN | $26K | — | $26K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | DELTA DENTAL OF CALIFORNIA | $9K | — | $9K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $5K | $11K | 25.36% |
| COLONIAL LIFE & ACCIDENT3 Filed as: COLONIAL - SEE ATTACHMENT | PO BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $198 | $6K | 14.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | VISION SERVICE PLAN | $1K | — | $1K | 5.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | NATIONAL HEALTH INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $2K | $6K | 25.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $903 | $635 | $2K | 25.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | EMPATHIA PACIFIC, INC. | $429 | — | $429 | 8.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD, SUITE 100 SAN DIEGO, CA 92121 | ZURICH AMERICAN INSURANCE COMPANY | $343 | — | $343 | 19.99% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 9855 SCRANTON RD., SUITE 100 SAN DIEGO, CA 92121 | ZURICH AMERICAN INSURANCE COMPANY | $3 | — | $3 | 18.75% |
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 | 231 | 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) | 231 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 241 | $2.0M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 133 | $212K |
| Vision(2 contracts, 2 carriers) | SHARP HEALTH PLAN | 185 | $546K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 231 | $45K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 41 | $43K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 231 | $23K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 241 | $2.0M |
| Other(5 contracts, 4 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 255 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.