| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS INC. | 36 S. CHARLES ST BALTIMORE, MD 21201 | AETNA LIFE INSURANCE CO. | — | $60K | $60K | 0.46% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS INC. | 36 S. CHARLES ST BALTIMORE, MD 21201 | AETNA LIFE INSURANCE CO. | — | $60K | $60K | 0.46% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS INC. | 36 S. CHARLES ST BALTIMORE, MD 21201 | AETNA LIFE INSURANCE CO. | — | $8K | $8K | 0.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA, INC. PHARMACY BENEFIT MANAGER | Float revenue; Claims processing; Direct payment from the plan; Other fees Service code 12 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $2.9M |
| COHEN, WEISS AND SIMON LLP EIN 13-1592323 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 900 THIRD AVENE NEW YORK, NY 10022 | $219K |
| CLARITY TESTING SERVICES EIN 13-3869722 MEDICAL CONSULTANT | Claims processing; Direct payment from the plan Service code 12 | 150 WHITE PLAINS ROAD STE 204 TARRYTOWN, NY 10591 | $150K |
| PRUDENTRX LLC EIN 84-4560702 PHARMACY BENEFIT MANAGER | Other fees; Direct payment from the plan; Claims processing; Float revenue Service code 12 | PO BOX 746669 ATLANTA, GA 30374 | $92K |
| BOLTON PARTNERS NORTHEAST, INC. EIN 27-3666661 ACTUARY | Consulting fees; Direct payment from the plan; Actuarial Service code 11 | 9000 MIDLANTIC DRIVE, SUITE 100 MOUNT LAUREL, NJ 08054 | $84K |
| WAGNER & ZWERMAN LLP EIN 11-2836481 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | 201 OLD COUNTRY ROAD, STE 202 MELVILLE, NY 11747 | $73K |
| ANDREW MACKLE EIN 13-6123972 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | 160 SOUTH CENTRAL AVENUE ELMSFORD, NY 10523 | $46K |
| MERRILL LYNCH EIN 13-5674085 INV. CUSTODIAN/MANAGER | Investment management fees paid directly by plan; Custodial (securities); Investment management Service code 19 | 26 CENTURY HILL DRIVE LATHAM, NY 12110 | $38K |
| BRENDA RITCH EIN 13-6123972 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 SOUTH CENTRAL AVENUE ELMSFORD, NY 10523 | $28K |
| JEFFREY ALTHOLZ, MD EIN 06-8423547 MEDICAL CONSULTANT | Direct payment from the plan; Consulting fees; Consulting (general) Service code 16 | 150 WHITE PLAINS ROAD STE 204 TARRYTOWN, NY 10591 | $28K |
| TPA CORPORATION EIN 13-3329882 COMPUTER CONSULTANT | Direct payment from the plan; Consulting fees; Consulting (general) Service code 16 | PO BOX 433 CARMEL, NY 10512 | $20K |
| WESTCHESTER MEDICAL CARE PLLC EIN 20-0106098 MEDICAL CONSULTANT | Consulting fees; Direct payment from the plan; Consulting (general) Service code 16 | 150 WHITE PLAINS ROAD STE 201 TARRYTOWN, NY 10591 | $20K |
| THEODOR H. BROWN DDS EIN 13-3043628 DENTAL CONSULTANT | Direct payment from the plan; Consulting fees; Consulting (general) Service code 16 | 358 NORTH BROADWAY SLEEPY HOLLOW, NY 10591 | $19K |
| LOWER HUDSON VALLEY E.A.P. EIN 13-3240307 MEDICAL CONSULTANT | Consulting fees; Consulting (general); Direct payment from the plan Service code 16 | 3505 HILL BLVD, SUITE A YORKTOWN HEIGHTS, NY 10598 | $13K |
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 | 915 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 227 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 66 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 2,238 | $20.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,238 | — |
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.