| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN BLASCH | 71 BEECHWOOD LANE BERKELEY HEIGHTS, NJ 07922 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $27K | — | $27K | — |
| DAVID FEINSTEIN3 Filed as: DAVID S. FEINSTEIN | PARKWAY PLAZA II, 30 UNDERCLIFF AVE ELMSFORD, NY 10523 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $19K | — | $19K | — |
| FAGE BENEFITS SOLUTIONS LLC3 | PARKWAY PLAZA II, 30 UNDERCLIFF AVE ELMSFORD, NY 10523 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $0 | — | $0 | — |
| DAVID FEINSTEIN3 Filed as: DAVID S. FEINSTEIN | 46 BRUNDIGE DRIVE GOLDENS BRIDGE, NY 10526 | EMBLEMHEALTH 1 | $63K | — | $63K | — |
| DAVID FEINSTEIN3 Filed as: DAVID S. FEINSTEIN | 46 BRUNDIGE DRIVE GOLDEN BRIDGE, NY 10526 | EMBLEMHEALTH 2 | $77K | — | $77K | — |
| DAVID FEINSTEIN3 Filed as: DAVID S. FEINSTEIN | 46 BRUNDIGE DRIVE GOLDENS BRIDGE, NY 10526 | EMBLEMHEALTH 3 | $4K | — | $4K | — |
| FAGE BENEFITS SOLUTIONS LLC3 | PARKWAY PLAZA II, 30 UNDERCLIFF AVE ELMSFORD, NY 10523 | SOLSTICE HEALTH INSURANCE COMPANY | $4K | — | $4K | — |
| LISA PECONE Filed as: LISA S PECONE | 116 REDFERN DR CARY, NC 275188609 | UNITEDHEALTHCARE INSURANCE COMPANY | $70K | — | $70K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIOSCURI ADMINISTRATOR INC. EIN 11-3408631 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | 212-07 16TH AVENUE, 2ND FLOOR BAYSIDE, NY 11360 | $90K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 3 SURREY LANE HEMPSTEAD, NY 11550 | $18K |
| GETTRY MARCUS CPA PC EIN 13-3418879 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | 88 FROEHLICH BLVD, 3RD FLOOR WOODBURY, NY 11797 | $13K |
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 | 375 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 375 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC | 191 | $0 |
| Dental | SOLSTICE HEALTH INSURANCE COMPANY | 0 | $0 |
| Vision | SOLSTICE HEALTH INSURANCE COMPANY | 0 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.