| 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 | HEALTH NET | $165K | — | $165K | 1.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DR. WEST, SUITE 1500 LOS ANGELES, CA 90045 | DELTA DENTAL OF CALIFORNIA | $13K | — | $13K | 3.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DR. WEST, SUITE 1500 LOS ANGELES, CA 90045 | DELTA DENTAL OF CALIFORNIA | $24K | — | $24K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $39K | $4K | $43K | 20.75% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | ONE ENTERPRISE DRIVE, SUITE 210 SHELTON, CT 06484 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $38K | — | $38K | 18.20% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $2K | $6K | 2.83% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DR. WEST, SUITE 1500 LOS ANGELES, CA 90045 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $21K | $2K | $23K | 17.73% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 13.35% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | 897 12TH STREET HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $114 | $5K | 3.97% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | ONE ENTERPRISE DRIVE, SUITE 210 SHELTON, CT 06484 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 1.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DR. WEST, SUITE 1500 LOS ANGELES, CA 90045 | EYEMED VISION CARE | $9K | — | $9K | 7.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $2K | $14K | 12.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $722 | $4K | 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 | 1,225 | 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) | 1,228 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 1,124 | $8.5M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 663 | $596K |
| Vision | EYEMED VISION CARE | 1,979 | $125K |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,225 | $360K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 699 | $209K |
| Prescription drug | HEALTH NET | 1,124 | $8.5M |
| Other(3 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,225 | $279K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,979 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.