| 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 COMPANY | $49K | $20K | $69K | 7.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST UNUM LIFE INSURANCE COMPANY | $45K | $18K | $62K | 7.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | KAISER FOUNDATION HEALTH PLAN INC | — | $2K | $2K | 0.50% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | FIRST UNUM LIFE INSURANCE COMPANY | $92K | $9K | $101K | 22.00% |
| TRIBEN INSURANCE SOLUTIONS INC3 | 24 EAST 2ND STREET, 1ST FLOOR MEDIA, PA 19063 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $469 | $2K | 7.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 ADMINISTRATOR | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $1.7M |
| UNUM LIFE INSURANCE COMPANY OF AM. EIN 01-0278678 ADMINISTRATOR | Contract Administrator Service code 13 | — | $83K |
| RXBENEFITS, INC. EIN 63-1157085 ADMINISTRATOR | Contract Administrator Service code 13 | — | $22K |
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 | 2,898 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,927 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 93 | $1.1M |
| Dental(2 contracts) | DELTA DENTAL OF NEW YORK | 3,304 | $1.9M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 3,618 | $117K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 2,898 | $892K |
| Short-term disability(2 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 2,307 | $1.0M |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 1,777 | $460K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 3,840 | $2.3M |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 2,898 | $892K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,840 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.