| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 2600 SOUTH TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | KAISER FOUNDATION HEALTH PLAN, INC. | $30K | $0 | $30K | 3.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2600 SOUTH TELEGRAPH ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | METROPOLITAN LIFE INSURANCE COMPANY | $32K | $107 | $33K | 10.09% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $5K | $5K | 1.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $194 | $194 | 0.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | FIRST UNUM LIFE INSURANCE COMPANY | $21K | $0 | $21K | 6.57% |
| CATHERINE MICHELLE DOBRATZ3 Filed as: CATHERINE M. DOBRATZ | 9903 EAST 150TH AVENUE BRIGHTON, CO 80602 | FIRST UNUM LIFE INSURANCE COMPANY | $15K | $0 | $15K | 4.64% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | FIRST UNUM LIFE INSURANCE COMPANY | $0 | $5K | $5K | 1.64% |
| CATHERINE MICHELLE DOBRATZ3 Filed as: CATHERINE M. DOBRATZ | 9903 EAST 150TH AVENUE BRIGHTON, CO 80602 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $11K | $0 | $11K | 9.76% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $7K | $0 | $7K | 6.66% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $0 | $728 | $728 | 0.65% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | VISION SERVICE PLAN | $2K | $0 | $2K | 4.19% |
| A SECURE YOU INC4 Filed as: A SECURE YOU INC. | 63 SABLE RUN EAST AMHERST, NY 14051 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | $0 | $2K | 14.38% |
| GALLAGHER BENEFIT SERVICES, INC.4 | 2850 GOLF ROAD, SUITE 1000 ROLLING MEADOWS, IL 60008 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $345 | $0 | $345 | 3.10% |
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $190 | $0 | $190 | 1.71% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2600 SOUTH TELEGRAPH, ROAD SUITE 100 BLOOMFIELD HILLS, MI 48302 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $749 | $0 | $749 | 9.88% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 95287 CHICAGO, IL 60694 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $0 | $108 | $108 | 1.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $0 | $5 | $5 | 0.07% |
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 | 510 | 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) | 510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 118 | $795K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 914 | $330K |
| Vision | VISION SERVICE PLAN | 453 | $39K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 510 | $318K |
| Short-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 510 | $318K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 510 | $318K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 118 | $795K |
| Other(5 contracts, 5 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 660 | $494K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 914 | — |
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.