| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY | 333 WEST 34TH STREET NEW YORK, NY 10001 | THE UNION LABOR LIFE INSURANCE COMPANY | $10K | — | $10K | 1.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE CO. EIN 06-6033492 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.5M |
| EMPLOYEE A EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $254K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $195K |
| EMPLOYEE B EIN 06-0960814 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $159K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $96K |
| ROBERT M. CHEVERIE & ASSOCIATES P.C EIN 06-1335139 NONE | Other fees; Legal; Direct payment from the plan Service code 29 | — | $87K |
| EMPLOYEE D EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $82K |
| EMPLOYEE F EIN 06-0960814 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $61K |
| EMPLOYEE E EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $59K |
| EMPLOYEE G EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE H EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $54K |
| EMPLOYEE I EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $44K |
| EMPLOYEE L EIN 06-0960814 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $43K |
| EMPLOYEE J EIN 06-0960814 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $41K |
| EMPLOYEE K EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $39K |
| EMPLOYEE C EIN 06-0960814 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $38K |
| EMPLOYEE M EIN 06-0960814 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $37K |
| T.M. BYXBEE CO. EIN 06-1386456 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $33K |
| EMPLOYEE N EIN 06-0960814 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $30K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Accounting (including auditing); Other fees Service code 10 | — | $27K |
| SEGAL MARCO ADVISORS EIN 13-2646110 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $24K |
| FIRST AMERICAN ADMINISTRATORS, INC. EIN 86-0773195 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $15K |
| PRINCIPAL CUSTODIAL SOLUTIONS EIN 42-1520346 NONE | Custodial (other than securities); Direct payment from the plan; Custodial (securities) Service code 18 | — | $7K |
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 | 2,539 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,401 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,940 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 3,003 | $343K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 2,487 | $826K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 3,003 | $343K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,003 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.