| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $35K | $10K | $45K | 6.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $1K | $9K | 10.94% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $174 | $2K | 16.95% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $732 | $732 | 8.18% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $149 | $149 | 1.67% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $622 | $102 | $724 | 10.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $967 | $100 | $1K | 16.55% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: BOLTON & COMPANY | 3475 FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $732 | $732 | 11.36% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $86 | $86 | 1.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $495 | $92 | $587 | 11.87% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $218 | $218 | 4.41% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $79 | $79 | 1.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $353 | $59 | $412 | 11.68% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $115 | $115 | 3.26% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $51 | $51 | 1.45% |
| HUB INTERNATIONAL MIDWEST LIMITED5 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $732 | $732 | 28.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $389 | $45 | $434 | 16.72% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $38 | $38 | 1.46% |
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 | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 186 | $662K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 190 | $90K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 190 | $83K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $12K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 28 | $6K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 186 | $662K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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.
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.