| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DEBRA INTERNICOLA3 | 333 WESTCHESTER AVE WHITE PLAINS, NY 10604 | AMALGAMATED LIFE INSURANCE COMPANY | $2K | — | $2K | 0.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC EIN 23-7391136 NONE | Other commissions; Other services; Claims processing; Insurance brokerage commissions and fees; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Insurance agents and brokers Service code 12 | — | $2.7M |
| MARSHALL & MOSS PAYROLL COMPLIANCE EIN 04-3652965 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $222K |
| STATE STREET GLOBAL ADVISORS TRUST EIN 81-4017137 NONE | Investment management fees paid directly by plan; Custodial (securities); Investment management Service code 19 | — | $222K |
| WALTER SARACENI EIN 11-1538293 EMPLOYEE | Employee (plan); Recordkeeping fees Service code 30 | — | $198K |
| THE SEGAL GROUP EIN 13-1835864 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $159K |
| UNITED BEHAVIORAL HEALTH NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $148K |
| VIRGINIA & AMBINDER, LLP EIN 13-4166736 NONE | Legal; Direct payment from the plan Service code 29 | — | $132K |
| GLORIA MATERON EIN 11-1538293 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $128K |
| SILVERSCRIPT INSURANCE COMPANY EIN 20-2833904 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $121K |
| ADMINISTRATIVE SERVICES ONLY EIN 11-2995970 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $115K |
| BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Investment management; Other services; Investment management fees paid directly by plan Service code 28 | — | $113K |
| O'DONOGHUE & O'DONOGHUE LLP EIN 51-0120528 NONE | Legal; Direct payment from the plan Service code 29 | — | $112K |
| WENDY SALVATIERRA EIN 11-1538293 NONE | Recordkeeping fees; Employee (plan) Service code 30 | — | $112K |
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $95K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $90K |
| KAUFF MCGUIRE & MARGOLIS LLP EIN 13-3573855 NONE | Legal; Direct payment from the plan Service code 29 | — | $76K |
| INNOVATIVE SOFTWARE SOLUTIONS INC EIN 23-2182079 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $74K |
| LINDA SCARPA EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $70K |
| MARIA FROGIERO EIN 11-1538293 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $60K |
| LAURIE KILLIEBREW EIN 11-1538293 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $56K |
| DIANA PETRACCIONE EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $55K |
| ANAPA TRISTA GEORGE EIN 11-1538293 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
| MALKIA MCLUNE EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $54K |
| ROSA BERTOLINI EIN 11-1538293 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $54K |
| ERICKA SIMPSON EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $54K |
| BETSEY PADGETT EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $53K |
| MINDY FEIERMAN EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $52K |
| LOCKTIGHT SOLUTIONS INC NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 2166 BROADWAY, SUITE 17D NEW YORK, NY 10024 | $51K |
| MIHAELA DUMITRU EIN 11-1538293 EMPLOYEE | Recordkeeping fees; Employee (plan) Service code 30 | — | $39K |
| ADVANCEPCS EIN 75-2493381 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $38K |
| SAMANTHA TABALA EIN 11-1538293 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $36K |
| TYTUS STEMPNIEWICZ EIN 11-1538293 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $35K |
| MEKETA INVESTMENT GROUP EIN 04-2659023 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $30K |
| PAYCHEX, INC. EIN 16-1124166 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $29K |
| PERFECT PRINT SOLUTIONS, INC. NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $22K |
| TRIBORO PRINTING NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $20K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 NONE | Insurance brokerage commissions and fees Service code 53 | — | $367 |
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 | 3,218 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 738 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,956 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 4,300 | $663K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE INC | 3,418 | $278K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,300 | — |
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."
No prospect flags tripped on this filing.