| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: COOK, MARAN AND ASSOCIATES INC. | 461 PANTIAGO ROAD EAST HAMPTON, NY 11937 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $76K | $0 | $76K | 1.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $33K | $0 | $33K | 0.52% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE AGENCY INC. | ONE EMPIRE DRIVE RENSSELAER, NY 12144 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $33K | $0 | $33K | 0.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: COOK, MARAN AND ASSOCIATES INC. | 40 MARCUS DRIVE, 3RD FLOOR MELVILLE, NY 11747 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $12K | $20K | 5.79% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 2850 GOLF ROAD, 5TH FLOOR ROLLING MEADOWS, IL 60008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 0.60% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE AGENCY INC. | ONE EMPIRE DRIVE RENSSELAER, NY 12144 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 0.60% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: COOK, MARAN AND ASSOCIATES INC. | 461 PANTIAGO ROAD EAST HAMPTON, NY 11937 | EMPIRE HEALTHCHOICE HMO, INC. | $3K | $0 | $3K | 1.19% |
| GALLAGHER BENEFIT SERVICES, INC.3 | TWO PIERCE PLACE ITASCA, IL 60143 | EMPIRE HEALTHCHOICE HMO, INC. | $1K | $0 | $1K | 0.52% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE AGENCY INC. | ONE EMPIRE DRIVE RENSSELAER, NY 12144 | EMPIRE HEALTHCHOICE HMO, INC. | $1K | $0 | $1K | 0.52% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: COOK, MARAN AND ASSOCIATES INC. | 17-17 ROUTE 208, SUITE 260 FAIR LAWN, NJ 07410 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | $16K | $22K | 8.31% |
| GROUP INSURANCE SERVICES INC3 Filed as: GROUP INSURANCE AGENCY INC. | 1 EMPIRE DRIVE RENSSELAER, NY 12144 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $3K | $5K | 1.85% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 250 PARK AVENUE, 3RD FLOOR NEW YORK, NY 10177 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $0 | $2K | 0.80% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 777 108TH AVENUE NE, SUITE 200 BELLEVUE, WA 98004 | MUTUAL OF OMAHA INSURANCE COMPANY | $0 | $302 | $302 | 0.12% |
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 | 552 | 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) | 552 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 552 | $6.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $343K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $343K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $343K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 660 | $261K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 660 | $261K |
| Prescription drug(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 552 | $6.7M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 387 | $343K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 660 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.