| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | KAISER FOUNDATION HEALTH PLAN INC. | $12K | $0 | $12K | 2.34% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 500 N BRAND BLVD STE 100 GLENDALE, CA 91203 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | $0 | $3K | 0.57% |
| CAPITAL CITY BENEFITS3 Filed as: CAPITAL CITY BENEFITS AND INSURANCE | 400 SUNRISE AVENUE ROSEVILLE, CA 95661 | HEALTH NET | $5K | $0 | $5K | 3.06% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 3697 MT DIABLO BLVD SUITE 300 LAFAYETTE, CA 94549 | HEALTH NET | $2K | $0 | $2K | 1.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | GUARDIAN | $3K | $0 | $3K | 9.90% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP INC | — | GUARDIAN | $0 | $1K | $1K | 3.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 333 EAST OSBORN RD STE 27 STE 270 PHOENIX, AZ 90039 | GUARDIAN | $558 | $0 | $558 | 1.63% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $616 | $45 | $661 | 6.97% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $354 | $0 | $354 | 3.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $43 | $43 | 0.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | EYEMED VISION CARE | $297 | $0 | $297 | 3.99% |
| FLEXVISION - MD3 Filed as: FLEXVISION MD | 15400 CALHOUN DRIVE, SUITE 125 ROCKVILLE, MD 20855 | EYEMED VISION CARE | $99 | $0 | $99 | 1.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: DICKERSON EMPLOYEE BENEFITS | 1918 RIVERSIDE DRIVE LOS ANGELES, CA 90039 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $478 | $0 | $478 | 11.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $134 | $0 | $134 | 3.29% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $11 | $11 | 0.27% |
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 | 160 | 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) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 59 | $684K |
| Dental(2 contracts, 2 carriers) | HEALTH NET | 132 | $188K |
| Vision(2 contracts, 2 carriers) | HEALTH NET | 97 | $161K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 157 | $14K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 157 | $9K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 59 | $530K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 157 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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.