| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | CALIFORNIA PHYSICIANS SERVICE | $213K | $183 | $213K | 3.53% |
| STRATEGIC EMPLOYEE BENEFIT SERVICES3 | 200 SW MARKET STREET, SUITE 1600 PORTLAND, OR 97201 | MODA HEALTH | $10K | — | $10K | 2.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 7.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 7.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | EYEMED VISION CARE | $5K | — | $5K | 9.40% |
| STRATEGIC EMPLOYEE BENEFIT SERVICES3 | 200 SW MARKET STREET, SUITE 1600 PORTLAND, OR 97201 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $1K | — | $1K | 2.54% |
| STRATEGIC EMPLOYEE BENEFIT SERVICES3 | 200 SW MARKET STREET, SUITE 1600 PORTLAND, OR 97201 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 13.06% |
| STRATEGIC EMPLOYEE BENEFIT SERVICES3 | 200 SW MARKET STREET, SUITE 1600 PORTLAND, OR 97201 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $88 | — | $88 | 16.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $32K | $8K | $40K | — |
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 | 576 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 595 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 505 | $6.4M |
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 429 | $46K |
| Vision | EYEMED VISION CARE | 729 | $58K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 480 | $99K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 50 | $21K |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 578 | $90K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 505 | $6.4M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 480 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 729 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.