| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS NORTHEAST, INC. | 9000 MID ALANTIC DRIVE SUITE 100 MT. LAUREL, NJ 08054 | THE UNION LABOR LIFE INSURANCE COMPANY | $7K | — | $7K | 3.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL DISTRICT PHYSICIAN'S HEALTH EIN 14-1641028 NONE | Claims processing Service code 12 | 500 PATROON CREEK BLVD ALBANY, NY 12206 | $146K |
| CHRISTOPHER BAXTER EIN 14-1418020 EMPLOYEE | Employee (plan) Service code 30 | 37 LUZERNE ROAD QUEENSBURY, NY 12801 | $93K |
| KETHEM NOVICK EIN 14-1418020 EMPLOYEE | Employee (plan) Service code 30 | 37 LUZERNE ROAD QUEENSBURY, NY 12804 | $69K |
| ATALANTA SOSNOFF EIN 20-0461050 NONE | Investment management Service code 28 | 505 5TH AVENUE, 17TH FLOOR NEW YORK, NY 10017 | $64K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Claims processing Service code 12 | PO BOX 52150 PHOENIX, AZ 85072 | $44K |
| BOLTON PARTNERS NORTHEAST, INC. EIN 27-3666661 NONE | Actuarial Service code 11 | 2277 STATE HIGHWAY 33 SUITE 409 TRENTON, NJ 08690 | $42K |
| BOSTON PARTNERS EIN 98-0202744 NONE | Investment management Service code 28 | 1 BEACON STREET 30TH FLOOR BOSTON, MA 02108 | $27K |
| MERRILL LYNCH EIN 13-5674085 NONE | Securities brokerage; Custodial (other than securities); Investment management; Sub-transfer agency fees Service code 18 | 250 VESEY STREET NEW YORK, NY 10281 | $23K |
| LOOMIS SAYLES EIN 04-3200030 NONE | Investment management Service code 28 | 1384 OLD FREEPORT ROAD, SUITE A2 PITTSBURGH, PA 15238 | $20K |
| KRAKOW, SOURIS & LANDRY EIN 04-3363718 NONE | Legal Service code 29 | 225 FRIEND STREET 503 BOSTON, MA 02114 | $18K |
| D'ARCANGELO & CO., LLP EIN 13-2550103 NONE | Accounting (including auditing) Service code 10 | 120 LOMOND COURT UTICA, NY 13502 | $15K |
| JOSEPH W. MCCARTHY & ASSOCS. SPECIA EIN 16-1120588 NONE | Accounting (including auditing) Service code 10 | 7644 RT. 31 WEST BALDWINSVILLE, NY 13027 | $14K |
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 | 332 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 72 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 404 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 0 | $107K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 266 | $217K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 266 | — |
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."
No prospect flags tripped on this filing.