| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 WOODBURY ROAD WOODBURY, NY 11797 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $39K | $3K | $42K | 1.90% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCS., INC. | PO BOX 3310 SANTA BARBARA, CA 93130 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $242 | $242 | 0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 100 SUNNYSIDE BOULEVARD WOODBURY, NY 11797 | AETNA LIFE INSURANCE COMPANY | $5K | $466 | $5K | 5.66% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LTD | 1393 VETERANS MEMORIAL HIGHWAY SUITE 210N HAUPPAUGE, NY 11788 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | $4K | $10K | 18.30% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LTD | 1393 VETERANS MEMORIAL HIGHWAY SUITE 210N HAUPPAUGE, NY 11788 | COMPANION LIFE INSURANCE COMPANY | $4K | $3K | $8K | 17.48% |
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 | 200 | 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) | 200 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 218 | $2.2M |
| Dental | AETNA LIFE INSURANCE COMPANY | 231 | $89K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 218 | $2.2M |
| Life insurance(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 200 | $99K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 200 | $54K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 200 | $54K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 218 | $2.2M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 200 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 231 | — |
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.