| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $58K | $0 | $58K | 9.24% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $0 | $5K | 0.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $25K | $0 | $25K | 6.02% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $0 | $6K | 1.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $9K | $0 | $9K | 3.33% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $113 | $0 | $113 | 0.04% |
| USI INSURANCE SERVICES LLC3 | 200 W CYPRESS CREEK RD #500 FORT LAUDERDALE, FL 33309 | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | $4K | $1K | $5K | 2.28% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 122 E 42ND STREET NEW YORK, NY 10168 | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | $5K | $0 | $5K | 1.98% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | $0 | $4K | 9.27% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $352 | $0 | $352 | 0.73% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1393 VETERANS MEMORIAL HWY STE 210N HAUPPAUGE, NY 11788 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 | 333 WESTCHESTER AVE 102 WHITE PLAINS, NY 10604 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $192 | $0 | $192 | 0.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC. EIN 23-7391136 STOP LOSS COVERAGE | Other fees; Other services; Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | P.O. BOX 11532A NEW YORK, NY 10286 | $1.5M |
| MAZARS USA LLP EIN 13-1459550 AUDITORS | Accounting (including auditing) Service code 10 | 135 W 50TH STREET SUITE 12 NEW YORK, NY 10020 | $38K |
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 | 1,954 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,982 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 5 | $56K |
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF NEW YORK | 1,655 | $1.9M |
| Vision(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 2,302 | $291K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 2,491 | $625K |
| Short-term disability(2 contracts, 2 carriers) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,534 | $291K |
| Long-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,470 | $465K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 2,173 | $1.9M |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 2,491 | $625K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,491 | — |
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.