| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARK FRISCH3 | 80 CROSSWAYS PARK WEST WOODBURY, NY 11797 | BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC. | $25K | — | $25K | 1.54% |
| JEROME TEPPER3 | 50 BROADWAY HAWTHORNE, NY 10532 | BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC. | $8K | — | $8K | 0.52% |
| JEROME TEPPER3 | 50 BROADWAY, STE. 2 HAWTHORNE, NY 10532 | UNITEDHEALTHCARE OF CALIFORNIA | $10K | — | $10K | 1.50% |
| JEROME TEPPER3 Filed as: JEROME TAPPER | 50 BROADWAY HAWTHORNE, NY 105321245 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $9K | — | $9K | 10.96% |
| INDIGO INSURANCE SERVICES3 | 446 MAIN STREET 5FL WORCESTER, MA 01608 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $6K | — | $6K | 7.00% |
| MARK FRISCH3 Filed as: MARK N. FRISCH | 8 LAMPPOST DRIVE REDDING, CT 068961120 | VISION SERVICE PLAN | $876 | — | $876 | 3.97% |
| JEROME TEPPER3 | 50 BROADWAY HAWTHORNE, NY 105321245 | VISION SERVICE PLAN | $292 | — | $292 | 1.32% |
| MARK FRISCH3 | 8 LAMPPOST DRIVE WEST REDDING, CT 06896 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 19.20% |
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 | 217 | 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) | 217 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS, INC. | 303 | $2.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 221 | $15K |
| Vision | VISION SERVICE PLAN | 218 | $22K |
| Life insurance | AMERICAN GENERAL LIFE INSURANCE COMPANY | 217 | $86K |
| Short-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 217 | $86K |
| Long-term disability | AMERICAN GENERAL LIFE INSURANCE COMPANY | 217 | $86K |
| Other | AMERICAN GENERAL LIFE INSURANCE COMPANY | 217 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.