| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK CHRISTOPHER HOLLAND3 Filed as: MARK C HOLLAND | PO BOX 38366 GERMANTOWN, TN 38183 | UNITED HEALTHCARE INSURANCE COMPANY | $7K | $0 | $7K | 12.79% |
| MARK CHRISTOPHER HOLLAND3 | PO BOX 38366 GERMANTOWN, TN 38183 | UNITED HEALTHCARE INSURANCE COMPANY | $2K | $0 | $2K | 6.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNITED HEALTHCARE INSURANCE COMPANY | $0 | $820 | $820 | 2.69% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF ROAD FL 4 ROLLING MEADOWS, IL 60008 | UNITED HEALTHCARE INSURANCE COMPANY | $0 | $732 | $732 | 2.40% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MID-ATLANTIC INC | 1445 RESEARCH BLVD SUITE 210 ROCKVILLE, MD 20850 | HARTFORD LIFE AND ACCIDENT | $62 | $0 | $62 | 3.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1591 GALBRAITH AVE SE GRAND RAPIDS, MI 49546 | HARTFORD LIFE AND ACCIDENT | $0 | $3 | $3 | 0.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 2120 PEWAUKEE ROAD SUITE 202 WAUKESHA, WI 53188 | HARTFORD LIFE AND ACCIDENT | $0 | $1 | $1 | 0.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 MEDICAL TPA | Claims processing Service code 12 | — | $18K |
| MARK HOLLAND AGENT | Insurance agents and brokers Service code 22 | PO BOX 38366 GERMANTOWN, TN 38183 | $17K |
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 | 58 | 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) | 58 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | UNITED HEALTHCARE INSURANCE COMPANY | 68 | $30K |
| Vision | UNITED HEALTHCARE INSURANCE COMPANY | 68 | $30K |
| Life insurance | UNITED HEALTHCARE INSURANCE COMPANY | 58 | $52K |
| Short-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 58 | $52K |
| Long-term disability | UNITED HEALTHCARE INSURANCE COMPANY | 58 | $52K |
| Stop-loss / reinsurancereinsurance | ALL SAVERS INSURANCE COMPANY | 34 | $145K |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 58 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 68 | — |
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.