| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $39K | — | $39K | 2.10% |
| ACRISURE LLC3 Filed as: CHERNOFF DIAMOND AND COMPANY, LLC | 725 RXR PLAZA EAST TOWER UNIONDALE, NY 11556 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $6 | — | $6 | 0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INC. SVCES., INC. | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | AETNA LIFE INSURANCE COMPANY | $4K | — | $4K | 4.41% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 1393 VETERANS MEMORIAL HIGHWAY SUITE 210N HAUPPAUGE, NY 11788 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | $2K | $8K | 15.22% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 1393 VETERANS MEMORIAL HIGHWAY SUITE 210N HAUPPAUGE, NY 11788 | COMPANION LIFE INSURANCE COMPANY | $5K | $2K | $7K | 14.00% |
No Schedule C service providers reported on this filing.
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 | 212 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 454 | $1.8M |
| Dental | AETNA LIFE INSURANCE COMPANY | 241 | $94K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 454 | $1.8M |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 212 | $47K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 212 | $53K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 212 | $53K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 454 | $1.8M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 212 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 454 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.