| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED4 Filed as: BOLTON PARTNERS' HEALTH PLAN CONSUL | 36 S. CHARLES ST., STE 1000 BALTIMORE, MD 21201 | THE UNION LABOR LIFE INSURANCE COMPANY | $5K | — | $5K | 2.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENESYS, INC. EIN 53-0257019 NONE | Plan Administrator Service code 14 | — | $370K |
| CAREFIRST PPO EIN 52-1330940 NONE | Claims processing Service code 12 | — | $211K |
| GORDON, FIENBLATT, LLC EIN 52-0627715 NONE | Legal Service code 29 | — | $93K |
| AMERICAN HEALTH HOLDING, INC EIN 31-1368946 NONE | Other services Service code 49 | — | $87K |
| CALL A DOCTOR PLUS EIN 46-1682881 NONE | Other services Service code 49 | — | $36K |
| CALIBRE CPA GROUP, PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | — | $29K |
| BOLTON PARTNERS EIN 52-1231144 NONE | Actuarial Service code 11 | — | $17K |
| PNC BANK NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | PO BOX 609 PITTSBURGH, PA 15230 | $15K |
| AMERICAN GRAPHICS PRINTING NONE | Copying and duplicating Service code 36 | 34895 GROESBECK HWY CLINTON TOWNSHIP, MI 48035 | $5K |
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 | 1,477 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 72 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,549 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 1,549 | $33K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,589 | $196K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 1,549 | $116K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,589 | — |
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."
No prospect flags tripped on this filing.