| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 100 SUNNYSIDE BLVD WOODBURY, NY 11797 | UNITEDHEALTHCARE INSURANCE COMPANY | $175K | — | $175K | 4.08% |
| FNA INSURANCE SERVICES INC3 | 1000 WOODBURY ROAD STE 403 WOODBURY, NY 11797 | UNITEDHEALTHCARE INSURANCE COMPANY | — | $63K | $63K | 1.46% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INS SERVICES INC | 1000 WOODBURY ROAD STE 403 WOODBURY, NY 11797 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | — | $19K | $19K | 6.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 1000 WOODBURY ROAD STE 403 WOODBURY, NY 11797 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $13K | — | $13K | 4.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | PO BOX 4047 CONCORD, CA 94524 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | — | $8K | $8K | 2.58% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST | 1000 WOODBURY ROAD WOODBURY, NY 11797 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $26K | — | $26K | 13.50% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INS SERVICES INS | 1000 WOODBURY ROAD SUITE 403 WOODBURY, NY 11797 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | — | $12K | $12K | 6.51% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | PO BOX 4047 CONCORD, CA 94524 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | — | $6K | $6K | 3.23% |
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 | 400 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 430 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 566 | $4.3M |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 695 | $297K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 695 | $297K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 480 | $190K |
| Short-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 480 | $190K |
| Long-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 480 | $190K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 566 | $4.3M |
| Other | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 480 | $190K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 695 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.