| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED BROKERAGE LTD3 Filed as: DIVERSIFIED BROKERAGE OF H.V., LTD. | 60 ERIE STREET PO BOX 179 GOSHEN, NY 10924 | OXFORD HEALTH INSURANCE INC | $35K | — | $35K | 3.85% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS INC. | 225 WIRELESS BLVD SUITE 200 HAUPPAUGE, NY 11788 | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S) | $5K | — | $5K | 5.00% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS INC. | 225 WIRELESS ROAD HAUPPAUGE, NY 11788 | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S) | $4K | — | $4K | 3.79% |
| DIVERSIFIED BROKERAGE LTD3 Filed as: DIVERSIFIED BROKERAGE OF HUDSON VA | PO BOX 179 GOSHEN, NY 10924 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $954 | — | $954 | 12.80% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GRP PLANS INC. | 225 WIRELESS BLVD #308 HAUPPAUGE, NY 11788 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $318 | $318 | 4.27% |
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 | 101 | 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) | 101 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | OXFORD HEALTH INSURANCE INC | 183 | $898K |
| Dental | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S) | 136 | $98K |
| Vision | OXFORD HEALTH INSURANCE INC | 183 | $898K |
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 0 | $7K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 0 | $7K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 0 | $7K |
| Other | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 0 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 183 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.