| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | AETNA HEALTH OF CALIFORNIA INC | $29K | — | $29K | 4.95% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | AETNA LIFE INSURANCE COMPANY | $15K | — | $15K | 5.15% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $14K | $802 | $14K | 17.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | KAISER FOUNDATION HEALTH PLAN INC | $650 | $16 | $666 | 4.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $811 | — | $811 | 5.00% |
| AMWINS3 Filed as: LISI, INC. | 1600 W HILLSDALE BLVD, SUITE 201 SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | — | $41 | $41 | 0.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 970 RESERVE DRIVE, SUITE 200 ROSEVILLE, CA 95678 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 22.37% |
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 | 96 | 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) | 103 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA INC | 96 | $905K |
| Dental(2 contracts, 2 carriers) | AFLAC | 95 | $93K |
| Vision(2 contracts, 2 carriers) | AFLAC | 95 | $93K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 111 | $99K |
| Short-term disability | AFLAC | 48 | $82K |
| Prescription drug(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA INC | 96 | $905K |
| Other(2 contracts, 2 carriers) | AFLAC | 111 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.