| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | CALIFORNIACHOICE | $18K | — | $18K | 3.82% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | CALIFORNIACHOICE | $8K | — | $8K | 1.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIACHOICE | $6K | — | $6K | 1.18% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 4.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $306 | — | $306 | 0.67% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $975 | — | $975 | 11.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $315 | — | $315 | 3.66% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $582 | — | $582 | 7.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $113 | — | $113 | 1.49% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $829 | — | $829 | 11.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $234 | — | $234 | 3.30% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $420 | — | $420 | 10.37% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $188 | — | $188 | 4.64% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $408 | — | $408 | 12.61% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $77 | — | $77 | 2.38% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $365 | — | $365 | 11.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $119 | — | $119 | 3.69% |
| HAUSER INC3 Filed as: HAUSER INC. | 5905 E. GALBRAITH ROAD SUITE 9000 CINCINNATI, OH 45236 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $125 | — | $125 | 11.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $34 | — | $34 | 3.22% |
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 | 108 | 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) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIACHOICE | 58 | $478K |
| Dental | UNITED OF OMAHA LIFE INSURANCE COMPANY | 69 | $46K |
| Vision | UNITED OF OMAHA LIFE INSURANCE COMPANY | 69 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $10K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 36 | $4K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $9K |
| Prescription drug | CALIFORNIACHOICE | 58 | $478K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 105 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.