| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE SHIELD OF CALIFORNIA | $0 | $68K | $68K | 5.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $37K | $1K | $38K | 3.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED CONCORDIA INSURANCE COMPANY | $10K | $0 | $10K | 9.96% |
| JASON DAVIS INSURANCE SERVICES INC3 | 8260 EAST ELLERFORD STREET LONG BEACH, CA 90808 | AFLAC | $4K | $1K | $5K | 8.57% |
| GLOBAL SHIELD INSURANCE AGENCY3 | 511 EAST 1ST STREET, SUITE H TUSTIN, CA 92780 | AFLAC | $5K | $0 | $5K | 7.28% |
| NICHOLAS K. GREEN3 | 2698 JUNIPERO AVENUE, SUITE 201B SIGNAL HILL, CA 90755 | AFLAC | $1K | $459 | $2K | 2.41% |
| MJ INSURANCE3 Filed as: JARRETT PAHOA AND VARIOUS AGENTS | 2698 JUNIPERO AVENUE, SUITE 201B SIGNAL HILL, CA 90755 | AFLAC | $757 | $285 | $1K | 1.66% |
| CLAUDIA P BABA3 Filed as: CLAUDIA P. BABA | PO BOX 4831 ORANGE, CA 92863 | AFLAC | $512 | $273 | $785 | 1.25% |
| ANGELA ANTONIA MENDEZ3 | 1561 WEST 227TH STREET TORRANCE, CA 90501 | AFLAC | $356 | $193 | $549 | 0.87% |
| JOSE RICARDO VELEZ3 | 7627 ALLENGROVE STREET DOWNEY, CA 90240 | AFLAC | $348 | $190 | $538 | 0.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $4K | $0 | $4K | 10.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVENUE, SUITE 300 CHICAGO, IL 92501 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $2K | $4K | 11.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $4K | $0 | $4K | 9.98% |
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 | 360 | 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) | 360 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 275 | $2.3M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA INSURANCE COMPANY | 260 | $132K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 473 | $41K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 319 | $100K |
| Short-term disability | AFLAC | 88 | $63K |
| Prescription drug(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 275 | $2.3M |
| Other(2 contracts, 2 carriers) | AFLAC | 319 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 473 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.