| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: WALSH DUFFIELD COMPANIES INC | 801 MAIN STREET BUFFALO, NY 142031215 | METROPOLITAN LIFE INSURANCE COMPANY | $21K | $2K | $23K | 5.44% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: WALSH DUFFIELD COMPANIES INC | 801 MAIN STREET BUFFALO, NY 14203 | DELTA DENTAL OF NEW YORK | $9K | — | $9K | 5.00% |
| THE MCCLAIN GROUP LLC | 104 WITHEROW RD SEWICKLEY, PA 15143 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5K | — | $5K | 35.18% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: WALSH DUFFIELD COMPANIES INC | 801 MAIN STREET BUFFALO, NY 14203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 23.28% |
| DONNA TROXELL | 706 WESTWOOD DR GIBSONIA, PA 15044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $337 | — | $337 | 2.51% |
| THE FEDELI GROUP | 5005 ROCKSIDE RD INDEPENDENCE, OH 44131 | THE PAUL REVERE LIFE INSURANCE COMPANY | $33 | — | $33 | 0.25% |
| STEPHEN JOSEPH JOYCE | 70 SARGENT DR AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1 | $1 | $2 | 0.01% |
| THE MCCLAIN GROUP LLC | 104 WITHEROW RD SEWICKLEY, PA 15143 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2K | — | $2K | 35.38% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: WALSH DUFFIELD COMPANIES INC | 801 MAIN STREET BUFFALO, NY 14203 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | — | $1K | 23.15% |
| DONNA TROXELL | 706 WESTWOOD DR GIBSONIA, PA 15044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $140 | — | $140 | 2.53% |
| THE FEDELI GROUP | 5005 ROCKSIDE RD INDEPENDENCE, OH 44131 | THE PAUL REVERE LIFE INSURANCE COMPANY | $31 | — | $31 | 0.56% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: WALSH DUFFIELD COMPANIES, INC | 801 MAIN STREET BUFFALO, NY 142031215 | FEDERAL INSURANCE COMPANY | $608 | — | $608 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 | Claims processing; Contract Administrator Service code 12 | — | $16K |
| AETNA BEHAVIORAL HEALTH | Plan Administrator Service code 14 | 151 FARMINGTON AVENUE RSAA HARTFORD, CT 06156 | $8K |
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 | 192 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 34 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 226 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHNOW NEW YORK, INC. D/B/A BLUECROSS BLUESHIELD OF WNY | 513 | $2.6M |
| Dental | DELTA DENTAL OF NEW YORK | 575 | $171K |
| Vision | VISION SERVICE PLAN | 220 | $51K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 695 | $421K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 695 | $421K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 695 | $421K |
| Prescription drug | HEALTHNOW NEW YORK, INC. D/B/A BLUECROSS BLUESHIELD OF WNY | 513 | $2.6M |
| Other(3 contracts, 3 carriers) | HEALTHNOW NEW YORK, INC. D/B/A BLUECROSS BLUESHIELD OF WNY | 695 | $3.0M |
| 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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.