| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIGITAL INSURANCE LLC3 | 200 GALLERIA PARKWAY SE, SUITE 1950 ATLANTA, GA 30339 | UNITEDHEALTHCARE INSURANCE COMPANY | $182K | — | $182K | 1.82% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 1411 OPUS PL STE 450 DOWNERS GROVE, IL 59092 | UNITEDHEALTHCARE INSURANCE COMPANY | $147K | — | $147K | 1.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | PO BOX 2158 RIVERSIDE, CA 92506 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 0.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 | 55 E JACKSON BLVD CHICAGO, IL 606044466 | KAISER FOUNDATION HEALTH PLAN | $10K | — | $10K | 4.11% |
| DIGITAL INSURANCE LLC3 Filed as: DIGITAL INSURANCE, INC. | 200 GALLERIA PKWY SE STE 1950 ATLANTA, GA 303395946 | KAISER FOUNDATION HEALTH PLAN | $5K | — | $5K | 2.15% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED BEHAVIORAL HEALTH DBA OPTUM EIN 94-2649097 CONTRACT ADMINISTRATORS | Contract Administrator Service code 13 | — | $35K |
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 | 2,215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 845 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,060 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 2,211 | $10.0M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 2,211 | $10.0M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 2,211 | $10.0M |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 2,215 | $1.2M |
| Short-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 2,215 | $1.2M |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 2,215 | $1.2M |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 2,211 | $10.0M |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 2,215 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,215 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.