| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $29K | $0 | $29K | 4.16% |
| 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 | $7K | $0 | $7K | 1.02% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $0 | $5K | 1.29% |
| 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 | $246 | $0 | $246 | 0.07% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $10K | $0 | $10K | 3.06% |
| 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 | $941 | $0 | $941 | 0.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 122 E 42ND STREET NEW YORK, NY 10168 | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | -$10K | $0 | -$10K | -6.37% |
| TRIBEN INSURANCE SOLUTIONS INC4 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.17% |
| 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 | $458 | $0 | $458 | 0.73% |
| 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 | $29 | $0 | $29 | 0.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC. EIN 23-7391136 STOP LOSS COVERAGE | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator; Other fees Service code 12 | P.O. BOX 11532A NEW YORK, NY 10286 | $1.7M |
| MAZARS USA LLP EIN 13-1459550 AUDITORS | Accounting (including auditing) Service code 10 | 135 W 50TH STREET SUITE 12 NEW YORK, NY 10020 | $42K |
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 | 2,250 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 62 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,312 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF NEW YORK | 1,695 | $2.0M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 1,912 | $164K |
| Life insurance | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 44 | $699K |
| Short-term disability(2 contracts) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 4,031 | $380K |
| Long-term disability(2 contracts) | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,547 | $374K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 2,229 | $1.9M |
| Other | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 44 | $699K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,031 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.