| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | BLUE CROSS OF CALIFORNIA | $80K | $4K | $84K | 4.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $28K | — | $28K | 2.65% |
| AON CONSULTING INC3 Filed as: AON CONSULTING, INC. | PO BOX 905494 CHARLOTTE, NC 28290 | KAISER FOUNDATION HEALTH PLAN INC. | -$6K | — | -$6K | -0.54% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4695 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $22K | — | $22K | 9.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4895 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92660 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $7K | $1K | $9K | 15.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC. | 4895 MACARTHUR COURT, SUITE 600 NEWPORT BEACH, CA 92122 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $1K | $6K | 12.00% |
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 | 265 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 211 | $2.9M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 165 | $2.1M |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 375 | $108K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 375 | $55K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 211 | $2.9M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 375 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 375 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.