| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BLVD. WOODBURY, NY 11797 | EMBLEM HEALTH | $41K | $0 | $41K | 4.27% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BLVD. WOODBURY, NY 11797 | AETNA LIFE INSURANCE COMPANY | $12K | $5K | $17K | 4.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, LLC EIN 47-0854646 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $307K |
| HUB INTERNATIONAL NORTHEAST LIMITED EIN 13-3621603 BROKER | Other commissions Service code 55 | 1393 VETERANS HWY STE 210N HAUPPAUGE, NY 11788 | $0 |
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 | 827 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 827 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMBLEM HEALTH | 70 | $962K |
| Dental | AETNA LIFE INSURANCE COMPANY | 902 | $334K |
| Stop-loss / reinsurancereinsurance | UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK | 757 | $518K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 902 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.