| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VICTOR A CAMPANILE BROKERAGE INC3 | 2125 UTICA AVE BROOKLYN, NY 11234 | EMPIRE HEALTHCHOICE HMO, INC. | $15K | — | $15K | 1.31% |
| 5BOROUGHS INSURANCE AGENCY INC3 | 1110 SOUTH AVE STATEN ISLAND, NY 10314 | HIP HEALTH PLAN OF NY AN EMBLEM HEALTH COMPANY | $24K | — | $24K | 3.85% |
| TALL TREE ADMINISTRATORS3 | PO BOX 71747 SALT LAKE CITY, UT 84171 | SIRIUS AMERICA INSURANCE COMPANY | — | $48K | $48K | 11.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JOHN N MONGELLO EIN 11-1708617 HUSBAND- KATHY MONGELLO | Plan Administrator Service code 14 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $215K |
| JESSICA GAMBINO EIN 11-1708617 DAUGHTER- KATHY MONGELLO | Employee (plan) Service code 30 | 8 IROQUOIS DRIVE MANALAPAN, NJ 07726 | $143K |
| DEBORAH J SPADARO EIN 11-1708617 NONE | Employee (plan) Service code 30 | 1039 ROCKLAND AVE STATEN ISLAND, NY 10314 | $55K |
| UNITED LABOR SYSTEMS, LLC EIN 82-3261006 NONE | Consulting (general) Service code 16 | 360 E PARK AVE LONG BEACH, NY 11561 | $49K |
| S.A.KOENIG & ASSOCIATES CPAS, P.C. EIN 11-3141654 NONE | Accounting (including auditing) Service code 10 | 485 UNDERHILL BLVD SUITE 100 SYOSSET, NY 117913434 | $45K |
| PHYLLIS E SCAFIDI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 32 BAY 17TH ST BROOKLYN, NY 11214 | $43K |
| MONIKA OLSZEWSKI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 6764 78TH ST MIDDLE VILLAGE, NY 11379 | $39K |
| FETINA SMALLHORNE EIN 11-1708617 NONE | Employee (plan) Service code 30 | 1139 PARK PLACE BROOKLYN, NY 11212 | $36K |
| KATHY MONGELLO EIN 11-1708617 WIFE - JOHN MONGELLO | Employee (plan) Service code 30 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $32K |
| ROSEMARIE MONGIELLO EIN 11-1708617 NONE | Employee (plan) Service code 30 | 225 KENSINGTON ROAD LYNBROOK, NY 11563 | $31K |
| DDI CONSULTING SERVICES EIN 22-3369266 NONE | Consulting (general) Service code 16 | 221 SOMERVILLE ROAD BEDMINSTER, NJ 07921 | $25K |
| MULTIPLAN, INC. EIN 13-3068979 NONE | Contract Administrator Service code 13 | PO BOX 29395 GPO NEW YORK, NY 100879395 | $25K |
| STARR, GERN, DAVISON, & RUBIN, PC EIN 22-3241223 NONE | Legal Service code 29 | 105 EISENHOWER PARKWAY SUITE 401 ROSELAND, NJ 070681640 | $20K |
| VORMITTAG ASSOCIATES INC. EIN 11-2532460 NONE | Consulting (general) Service code 16 | 120 COMAC STREET RONKONKOMA, NY 11779 | $20K |
| PRAGER METIS CPAS, LLC EIN 06-1667465 NONE | Accounting (including auditing) Service code 10 | 99 SUNNYSIDE BLVD STE 101 WOODBURY, NY 11797 | $6K |
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 | 662 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 662 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EMPIRE HEALTHCHOICE HMO, INC. | 78 | $2.2M |
| Prescription drug | SIRIUS AMERICA INSURANCE COMPANY | 74 | $422K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 74 | $422K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 78 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.