| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE & FINANCIAL | SERVICES, INC. 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | SUTTER HEALTH PLAN | $16K | — | $16K | 3.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SUTTER HEALTH PLAN | $9K | — | $9K | 1.79% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FINANCIAL | SERVICES, INC. 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | KAISER FOUNDATION HEALTH PLAN INC. | $12K | — | $12K | 2.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | $1 | $5K | 1.00% |
| TSM INSURANCE & FINANCIAL SERVICES3 Filed as: TSM INSURANCE AND FINANCIAL | SERVICES, INC. 1317 OAKDALE ROAD, SUITE 910 MODESTO, CA 95355 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 7.18% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PARKWAY W, VIVA 16 SUITE 321 BLUE BELL, PA 19422 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | — | $5K | $5K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 3.56% |
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 | 183 | 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) | 183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 105 | $972K |
| Dental | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 191 | $103K |
| Vision | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 191 | $103K |
| Life insurance | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 191 | $103K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 105 | $972K |
| Other | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 191 | $103K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.