| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| VICTOR A CAMPANILE BROKERAGE INC3 | 2125 UTICA AVE BROOKLYN, NY 11234 | EMPIRE HEALTHCHOICE HMO, INC. | $9K | — | $9K | 1.12% |
| 5BOROUGHS INSURANCE AGENCY INC3 | 1110 SOUTH AVE STATEN ISLAND, NY 10314 | EMPIRE HEALTHCHOICE HMO, INC. | $4K | — | $4K | 0.54% |
| 5BOROUGHS INSURANCE AGENCY INC3 | 1110 SOUTH AVE STATEN ISLAND, NY 10314 | HIP HEALTH PLAN OF NY AN EMBLEM HEALTH COMPANY | $29K | — | $29K | 3.84% |
| EMERSON REID LLC3 Filed as: EMERSON REID, LLC | 261 MADISON AVE., STE# 602 NEW YORK, NY 10016 | SIRIUS AMERICA INSURANCE COMPANY | — | $32K | $32K | 62.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JOHN N MONGELLO EIN 11-1708617 HUSBAND-KATHY MONGELLO | Employee (plan) Service code 30 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $307K |
| LEAGUE OF INTERNATIONAL FEDERATED EIN 11-3358248 AFFILIATED UNION | Other services; Direct payment from the plan Service code 49 | 325 73RD STREET BROOKLYN, NY 11209 | $244K |
| JESSICA GAMBINO EIN 11-1708617 DAUGHTER-KATHY MONGELLO | Employee (plan) Service code 30 | 8 IROQUOIS DRIVE MANALAPAN, NJ 07726 | $146K |
| PRAGER METIS CPAS, LLC EIN 06-1667465 NONE | Accounting (including auditing) Service code 10 | 100 SUNNYSIDE BLVD, SUITE 200 WOODBURY, NY 11797 | $74K |
| DEBORAH J SPADARO EIN 11-1708617 NONE | Employee (plan) Service code 30 | 1039 ROCKLAND AVE STATEN ISLAND, NY 10314 | $66K |
| MONIKA OLSZEWSKI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 6764 78TH ST MIDDLE VILLAGE, NY 11379 | $62K |
| UNITED LABOR SYSTEMS, LLC EIN 82-3261006 NONE | Consulting (general) Service code 16 | 360 E PARK AVENUE LONG BEACH, NY 11561 | $54K |
| PHYLLIS E SCAFIDI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 32 BAY 17TH STREET BROOKLYN, NY 11214 | $51K |
| TALL TREE ADMINISTRATORS EIN 87-0672300 NONE | Claims processing; Contract Administrator Service code 12 | 11550 SOUTH 700 EAST, STE 200 DRAPER, UT 84020 | $37K |
| MULTIPLAN, INC EIN 13-3068979 NONE | Contract Administrator Service code 13 | P.O. BOX 29395, GPO NEW YORK, NY 100879395 | $32K |
| KATHY MONGELLO EIN 11-1708617 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 |
| DDI CONSULTING SERVICES EIN 22-3627411 NONE | Consulting (general); Direct payment from the plan Service code 16 | 221 SOMERVILLE ROAD BEDMINSTER, NJ 07921 | $17K |
| STARR, GERN, DAVISON & RUBIN PC EIN 22-3241223 AFFILIATED UNION ATTORNEY | Legal Service code 29 | 105 EISENHOWER PARKWAY, SUITE 401 ROSELAND, NJ 070681640 | $17K |
| GENERAL VISION SERVICES, LLC EIN 11-3580576 NONE | Contract Administrator; Claims processing Service code 12 | — | $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 | 663 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 665 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE HMO, INC. | 97 | $1.5M |
| Dental(2 contracts) | HEALTHPLEX | 26 | $51K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 64 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 97 | — |
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."
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.