| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST UNUM LIFE INSURANCE COMPANYNSURANCE COMPANY | $44K | $0 | $44K | 5.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST UNUM LIFE INSURANCE COMPANY | $44K | $0 | $44K | 5.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST UMUM LIFE INSURANCE COMPANY | $97K | $0 | $97K | 20.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC. EIN 23-7391136 STOP LOSS COVERAGE | Claims processing; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | P.O. BOX 11532A NEW YORK, NY 10286 | $1.4M |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 ADMINISTRATIVE SERVICE PR | Contract Administrator Service code 13 | — | $84K |
| HUB INTERNATIONAL NORTHEAST LIMITED | Insurance agents and brokers; Other commissions; Non-monetary compensation Service code 22 | 1000 WOODBURY ROAD WOODBURY, NY 11797 | $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 | 2,736 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 31 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,767 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DELTA DENTAL OF NEW YORK | 1,489 | $1.7M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 1,851 | $149K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 2,576 | $872K |
| Long-term disability | FIRST UMUM LIFE INSURANCE COMPANY | 1,701 | $486K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE INC. (G1921) | 1,951 | $1.8M |
| Other(3 contracts, 3 carriers) | FIRST UNUM LIFE INSURANCE COMPANYNSURANCE COMPANY | 2,576 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,576 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.