| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNITEDHEALTHCARE INSURANCE COMPANY | $28K | — | $28K | 2.51% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 11060 WHITE ROCK ROAD SUITE 160 RANCHO CORDOVA, CA 95670 | UNITEDHEALTHCARE INSURANCE COMPANY | $28K | — | $28K | 2.49% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 11060 WHITE ROCK ROAD SUITE 160 RANCHO CORDOVA, CA 956706061 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 1.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 1.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 601431203 | KAISER FOUNDATION HEALTH PLAN INC. | — | $802 | $802 | 0.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $4K | — | $4K | 1.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES INC. | 11060 WHITE ROCK ROAD SUITE 160 RANCHO CORDOVA, CA 956706061 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 1.23% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 601431203 | KAISER FOUNDATION HEALTH PLAN INC. | — | $340 | $340 | 0.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | GBS FINANCE TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 4.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | DELTA DENTAL OF CALIFORNIA | $4K | — | $4K | 3.27% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | GBS FINANCE TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | AETNA LIFE INSURANCE CO. | $5K | $2K | $6K | 6.11% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | AETNA LIFE INSURANCE CO. | $3K | — | $3K | 3.18% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | DELTA DENTAL OF CALIFORNIA | $801 | — | $801 | 4.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | GBS FINANCE TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | DELTA DENTAL OF CALIFORNIA | $774 | — | $774 | 3.93% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2 PIERCE PLACE 14TH FLOOR ITASCA, IL 601433177 | VISION SERVICE PLAN | $1K | — | $1K | 5.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 21ST FLOOR TWO PIERCE PLACE ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $86 | $1K | 7.93% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $13 | $1K | 7.43% |
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 | 194 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 138 | $1.9M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 115 | $148K |
| Vision | VISION SERVICE PLAN | 135 | $17K |
| Life insurance | AETNA LIFE INSURANCE CO. | 190 | $100K |
| Short-term disability | AETNA LIFE INSURANCE CO. | 190 | $100K |
| Long-term disability | AETNA LIFE INSURANCE CO. | 190 | $100K |
| Prescription drug(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 138 | $1.9M |
| Other(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 190 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 190 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.