| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VICTOR A CAMPANILE BROKERAGE INC3 | 2125 UTICA AVE BROOKLYN, NY 11234 | EMPIRE HEALTHCHOICE HMO, INC. | $26K | — | $26K | 2.24% |
| 5BOROUGHS INSURANCE AGENCY INC3 | 1110 SOUTH AVE STATEN ISLAND, NY 10314 | HIP HEALTH PLAN OF NY AN EMBLEM HEALTH COMPANY | $23K | — | $23K | 3.85% |
| TALL TREE ADMINISTRATORS3 | P.O. BOX 71747 SALT LAKE CITY, UT 84171 | SIRIUS AMERICA INSURANCE COMPANY | — | $46K | $46K | 15.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JOHN N MONGELLO EIN 11-1708617 HUSBAND-KATHY MONGELLO | Employee (plan) Service code 30 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $247K |
| JESSICA GAMBINO EIN 11-1708617 DAUGHTER-KATHY MONGELLO | Employee (plan) Service code 30 | 8 IROQUOIS DRIVE MANALAPAN, NJ 07726 | $117K |
| DEBORAH J SPADARO EIN 11-1708617 NONE | Employee (plan) Service code 30 | 1039 ROCKLAND AVE STATEN ISLAND, NY 10314 | $61K |
| MONIKA OLSZEWSKI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 6764 78TH ST MIDDLE VILLAGE, NY 11379 | $58K |
| PHYLLIS E SCAFIDI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 32 BAY 17TH STREET BROOKLYN, NY 11214 | $48K |
| PRAGER METIS CPAS, LLC EIN 06-1667465 NONE | Accounting (including auditing) Service code 10 | 100 SUNNYSIDE BLVD, SUITE 200 WOODBURY, NY 11797 | $46K |
| UNITED LABOR SYSTEMS, LLC EIN 82-3261006 NONE | Consulting (general) Service code 16 | 360 E PARK AVENUE LONG BEACH, NY 11561 | $40K |
| MULTIPLAN, INC EIN 13-3068979 NONE | Contract Administrator Service code 13 | P.O. BOX 29395, GPO NEW YORK, NY 100879395 | $33K |
| CHRISTOPHER L KUEHNE EIN 11-1708617 NONE | Employee (plan) Service code 30 | 2 CEFOLAS WAY VALLEY COTTAGE, NY 10989 | $32K |
| KATHY MONGELLO WIFE- JOHN MONGELLO | Employee (plan) Service code 30 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $32K |
| MARIE TODISCO EIN 11-1708617 NONE | Employee (plan) Service code 30 | 14 BANQUET COURT HOWELL, NJ 07731 | $22K |
| STARR, GERN, DAVISON & RUBIN PC EIN 22-3241223 NONE | Legal Service code 29 | 105 EISENHOWER PARKWAY, SUITE 401 ROSELAND, NJ 070681640 | $12K |
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 | 710 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 710 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EMPIRE HEALTHCHOICE HMO, INC. | 77 | $2.0M |
| Prescription drug | SIRIUS AMERICA INSURANCE COMPANY | 77 | $298K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 77 | $298K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 77 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.