| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVS | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | BLUE SHIELD OF CALIFORNIA | $49K | — | $49K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CALIFORNIA | PO BOX 2158 RIVERSIDE, CA 925162158 | KAISER FOUNDATION HEALTH PLANS INC. | $36K | $759 | $37K | 6.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVS | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | 2. RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $2K | $5K | 16.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL OF CA INSURANCE | 3390 UNIVERSITY AVE 300 RIVERSIDE, CA 92501 | 2. RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $437 | $437 | 1.35% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 3390 UNIVERSITY AVE 300 RIVERSIDE, CA 92501 | 5. RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 9.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVS | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | 4. RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $649 | $2K | 15.00% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVE 300 RIVERSIDE, CA 92501 | 4. RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $193 | $193 | 1.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVS | 4371 LATHAM ST STE 101 RIVERSIDE, CA 92501 | 1. RELIANCE STANDARD LIFE INSURANCE COMPANY | $542 | $247 | $789 | 16.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVE 300 RIVERSIDE, CA 92501 | 1. RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $72 | $72 | 1.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | 4371 LATHAM ST., 101 RIVERSIDE, CA 92501 | 6. RELIANCE STANDARD LIFE INSURANCE COMPANY | $335 | — | $335 | 14.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INSURANCE | 3390 UNIVERSITY AVE 300 RIVERSIDE, CA 92501 | 6. RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $32 | $32 | 1.43% |
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 131 | $1.5M |
| Vision | 5. RELIANCE STANDARD LIFE INSURANCE COMPANY | 250 | $18K |
| Life insurance(2 contracts, 2 carriers) | 4. RELIANCE STANDARD LIFE INSURANCE COMPANY | 121 | $18K |
| Long-term disability | 2. RELIANCE STANDARD LIFE INSURANCE COMPANY | 120 | $32K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 108 | $973K |
| Other(2 contracts, 2 carriers) | 1. RELIANCE STANDARD LIFE INSURANCE COMPANY | 121 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.