| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS, INC. | 9000 MIDLANTIC DRIVE, SUITE 100 MT LAUREL, NJ 08054 | THE UNION LABOR LIFE INSURANCE COMPANY | $16K | — | $16K | 1.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA, INC. EIN 06-6033492 PHARMACY BENEFIT MANAGER | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $2.5M |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 CLAIMS ADMINISTRATOR | Other services; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | ONE PENN PLAZA, 36TH FLOOR NEW YORK, NY 10119 | $754K |
| BLITMAN & KING LLP EIN 16-1047304 LEGAL | Legal; Direct payment from the plan Service code 29 | 443 N. FRANKLIN STREET, SUITE 300 SYRACUSE, NY 13204 | $159K |
| PARK AVENUE MEDICAL EIN 13-3925128 MEDICAL CONSULTANT | Claims processing; Direct payment from the plan Service code 12 | 160 SOUTH CENTRAL AVENUE ELMSFORD, NY 10523 | $138K |
| BOLTON PARTNERS NORTHEAST, INC. EIN 27-3666661 ACTUARY | Direct payment from the plan; Actuarial Service code 11 | 9000 MIDLANTIC DRIVE, SUITE 100 MT LAUREL, NJ 08054 | $84K |
| GETTRY MARCUS CPA, P.C. EIN 13-3418879 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | 88 FROEHLICH FARM BLVD, 3RD FLOOR WOODBURY, NY 11797 | $58K |
| PRUDENTRX LLC EIN 84-4560702 PHARMACY BENEFIT MANAGER | Direct payment from the plan; Claims processing; Float revenue Service code 12 | PO BOX 746669 ATLANTA, GA 30374 | $50K |
| BRENDA GALEA-RITCH EIN 13-6123972 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | 160 SOUTH CENTRAL AVENUE ELMSFORD, NY 10523 | $48K |
| MERRILL LYNCH EIN 13-5674085 INV. CUSTODIAN/MANAGER | Investment management fees paid directly by plan; Investment management; Custodial (securities) Service code 19 | 26 CENTURY HILL DRIVE LATHAM, NY 12110 | $36K |
| 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 | $29K |
| ARMANDO HERRERA EIN 13-6123972 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 SOUTH CENTRAL AVENUE ELMSFORD, NY 10523 | $27K |
| TPA CORPORATION EIN 13-3329882 COMPUTER CONSULTANT | Direct payment from the plan; Consulting (general); Consulting fees Service code 16 | PO BOX 433 CARMEL, NY 10512 | $23K |
| THEODOR H. BROWN DDS EIN 13-3043628 DENTAL CONSULTANT | Consulting (general); Direct payment from the plan; Consulting fees Service code 16 | 36 ST. THOMAS DRIVE PALM BEACH GARDENS, FL 33418 | $20K |
| CITRIN COOPERMAN & COMPANY, LLP EIN 22-2428965 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | 88 FROEHLICH FARM BLVD, 3RD FLOOR WOODBURY, NY 11797 | $13K |
| HESS TECHNOLOGY CONSULTING, INC. EIN 85-1115144 COMPUTER CONSULTANT | Consulting fees; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 1024 MCKINLEY STREET PEEKSKILL, NY 10566 | $6K |
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 | 927 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 213 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 44 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 0 | $74K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 903 | $937K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 903 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.