| 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 | $58K | — | $58K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $15K | — | $15K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2 PIERCE PL., 14TH FLOOR ITASCA, IL 601431203 | KAISER FOUNDATION HEALTH PLAN INC. | $422 | — | $422 | 0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 2.50% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | 2 PIERCE PL., 14TH FLOOR ITASCA, IL 601431203 | KAISER FOUNDATION HEALTH PLAN INC. | $193 | — | $193 | 0.05% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | DELTA DENTAL OF CALIFORNIA | $10K | — | $10K | 8.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 10.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 8.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC. | 2850 GOLF ROAD SUITE 1000 ROLLING MEADOWS, IL 600084036 | VISION SERVICE PLAN | $1K | — | $1K | 5.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 15.13% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $787 | — | $787 | 10.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $307 | — | $307 | 10.00% |
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 | 203 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 206 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 119 | $2.1M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 108 | $152K |
| Vision | VISION SERVICE PLAN | 143 | $18K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 203 | $58K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 203 | $8K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 203 | $26K |
| Prescription drug(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 119 | $2.1M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 203 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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.