| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 401 BROADHOLLOW ROAD STE 200 MELVILLE, NY 11747 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $41K | $41K | 2.00% |
| SAUL R LOCKER3 Filed as: SAUL EHRENFELD | 114 RICKY LANE LAKEWOOD, NJ 08701 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $41K | $41K | 2.00% |
| FNA INS SERVICES INC3 | 300 CONNELL DRIVE STE 3000 BERKELEY HEIGHTS, NJ 07922 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $24K | $24K | 1.17% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FIN SVC LLC | 12404 PARK CENTRAL DRIVE SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $17K | $17K | 0.83% |
| CREATIVE BUSINESS SOLUTIONS GRP INC3 | 4 GARDINER PLACE HUNTINGTON STATION, NY 11746 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | -$119 | -$119 | -0.01% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INS SVCS INC | 300 CONNELL DRIVE STE 3000 BERKELEY HEIGHTS, NJ 07922 | CIGNA HEALTH AND LIFE INSURANCE CO | — | $4K | $4K | 2.84% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FIN SVC | 12404 PARK CENTRAL DR STE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE CO | — | $3K | $3K | 2.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE | 401 BROADHOLLOW ROAD STE 200 MELVILLE, NY 11747 | CIGNA HEALTH AND LIFE INSURANCE CO | $2K | — | $2K | 1.56% |
| EHRENFELD S.3 Filed as: EHRENFELD, SAUL | 114 RICKY LN LAKEWOOD, NJ 08701 | CIGNA HEALTH AND LIFE INSURANCE CO | $2K | — | $2K | 1.56% |
| GAVIN MEIER3 | 14107 20TH AVE STE 507 WHITESTONE, NY 11357 | AFLAC | $3K | $33 | $3K | 2.90% |
| LORI ANN LOMBARDO3 | 459 TRESTLE WAY CONWAY, SC 29526 | AFLAC | $2K | $636 | $3K | 2.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 4 GARDINER PL HUNTINGTON STATION, NY 11746 | AFLAC | $2K | — | $2K | 1.93% |
| RICHARD PETERSON3 | 19 IDLE DAY DR CENTERPORT, NY 11721 | AFLAC | $1K | $33 | $1K | 1.09% |
| JASON M ANKER3 | 4 GARDINER PL HUNTINGTON STATION, NY 11746 | AFLAC | $1K | — | $1K | 1.02% |
| PETER LOMBARDO3 Filed as: PETER ANTHONY LOMBARDO | 63 BURLEIGH DR HOLBROOK, NY 11741 | AFLAC | $427 | $58 | $485 | 0.44% |
| RBA BENEFITS GROUP INC.3 Filed as: RBA BENEFITS GROUP INC | 77 DRIFTWOOD DR BRICK, NJ 08723 | AFLAC | $174 | — | $174 | 0.16% |
| JAMES R CLOSE3 | 419 SAINT CLAIR AVE SPRING LAKE, NJ 07762 | AFLAC | $173 | — | $173 | 0.16% |
| MICHAEL A FORNARO3 | 271 US HIGHWAY 46 STE H119 FAIRFIELD, NJ 07004 | AFLAC | $70 | — | $70 | 0.06% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN A PITUCH | PO BOX 335 SPARTA, NJ 07871 | AFLAC | $27 | — | $27 | 0.02% |
| MICHAEL DIGIACOMO3 | 41 GROVE ST OAK RIDGE, NJ 07438 | AFLAC | $21 | — | $21 | 0.02% |
| MICHAEL P ZORN3 | 10573 VERSAILLES BLVD WELLINGTON, FL 33449 | AFLAC | $18 | — | $18 | 0.02% |
| ALBERT SHUST3 | 200 CENTENNIAL AVE STE 105 PISCATAWAY, NJ 08854 | AFLAC | $11 | — | $11 | 0.01% |
| AMY K FOY3 | 804 MCCOY RD FRANKLIN LAKES, NJ 07417 | AFLAC | — | $8 | $8 | 0.01% |
| BENEFITMALL3 | 1133 WESTCHESTER AVE STE 229 WHITE PLAINS, NY 10604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 5.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 100 SUNNYSIDE BL STE 400 WOODBURY, NY 11797 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 3.75% |
| EHRENFELD S.3 Filed as: S. EHRENFELD | 114 RICKY LN LAKEWOOD, NJ 08701 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 3.75% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE LIM. | 1393 VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NY 11788 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $903 | — | $903 | 2.50% |
| EHRENFELD S.3 | 114 RICKY LN LAKEWOOD, NJ 08701 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $903 | — | $903 | 2.50% |
| LORI ANN LOMBARDO3 Filed as: LORI LOMBARDO | 459 TRESTLE WAY CONWAY, SC 29526 | AFLAC | $1K | $66 | $1K | 17.92% |
| GFM CORP3 | 2 HALYARD CT COLD SPRING HARBOR, NY 11724 | AFLAC | $445 | $17 | $462 | 5.59% |
| RICH PETERSON3 | 19 IDLE DAY DR CENTERPORT, NY 11721 | AFLAC | $258 | $17 | $275 | 3.33% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NE LMTD | 1114 MCDONALD AVE WANTAGH, NY 11793 | AFLAC | $47 | — | $47 | 0.57% |
| CREATIVE BUSINESS SOLUTIONS GRP INC3 Filed as: CREATIVE BUSINESS SOLUTIONS GRP | 1114 MCDONALD AVE WANTAGH, NY 11793 | AFLAC | $34 | — | $34 | 0.41% |
| PETER LOMBARDO3 Filed as: PETER LOMBARD | 63 BURLEIGH DR HOLBROOK, NY 11741 | AFLAC | $21 | $7 | $28 | 0.34% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LI | 1393 VETERANS MEMORIAL HIGHWAY STE 210N HAUPPAUGE, NY 11788 | UNUM LIFE INSURANCE COMPANY | $556 | $185 | $741 | 18.44% |
| FNA INSURANCE SERVICES INC2 | 100 SUNNYSIDE BLVD WOODBURY, NY 11797 | UNUM LIFE INSURANCE COMPANY | — | $116 | $116 | 2.89% |
| SAUL E.3 | 114 RICKY LANE LAKEWOOD, NJ 08701 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $229 | — | $229 | 5.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTL NORTHEAST LIMITED | 100 SUNNYSIDE BLVD STE 400 WOODBURY, NY 11797 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $229 | — | $229 | 5.98% |
| BENEFIT MALL3 | 1133 WESTCHESTER AE STE 229 WHITE PLAINS, NY 10604 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $191 | $191 | 4.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 MEDICAL CLAIMS PROCESSING | Claims processing Service code 12 | — | $82K |
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 | 235 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 235 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 177 | $2.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE CO | 129 | $152K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE CO | 129 | $152K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 10 | $4K |
| Other(5 contracts, 3 carriers) | AFLAC | 235 | $200K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 235 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.