| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 5BOROUGHS INSURANCE AGENCY INC3 | 1110 SOUTH AVENUE STATEN ISLAND, NY 10314 | EMBLEMHEALTH | $41K | — | $41K | 3.85% |
| EMERSON REID LLC3 Filed as: EMERSON REID, LLC | 261 MADISON AVE STE 602 NEW YORK, NY 10016 | SIRIUS AMERICA INSURANCE COMPANY | $15K | — | $15K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TALL TREE ADMINISTRATORS EIN 87-0672300 NONE | Claims processing; Contract Administrator Service code 12 | 11550 SOUTH 700 EAST STE 200 DRAPER, UT 84020 | $620K |
| JOHN N MONGELLO EIN 11-1708617 HUSBAND-KATHY MONGELLO | Employee (plan) Service code 30 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $293K |
| LEAGUE OF INTERNATIONAL FEDERATED EIN 11-3358248 AFFILIATED UNION | Other services Service code 49 | 325 73RD STREET BROOKLYN, NY 11209 | $287K |
| EMPIRE BLUECROSS NONE | Insurance services Service code 23 | PO BOX 11792 NEWARK, NJ 07101 | $149K |
| JESSICA GAMBINO EIN 11-1708617 DAUGHTER-KATHY MONGELLO | Employee (plan) Service code 30 | 8 IROQUOIS DRIVE MANALAPAN, NJ 07726 | $141K |
| EMPIRX HEALTH EIN 47-1226691 NONE | Claims processing; Contract Administrator Service code 12 | 155 CHESTNUT RIDGE ROAD MONTVALE, NJ 07645 | $80K |
| DEBORAH J SPADARO EIN 11-1708617 NONE | Employee (plan) Service code 30 | 1039 ROCKLAND AVENUE STATEN ISLAND, NY 10314 | $69K |
| MONICA OLSZEWSKI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 6764 78TH ST MIDDLE VILLAGE, NY 11379 | $66K |
| UNITED LABOR SYSTEMS EIN 82-3261006 NONE | Consulting (general) Service code 16 | 360 E PARK AVENUE LONG BEACH, NY 11561 | $59K |
| PHYLLIS E SCAFIDI EIN 11-1708617 NONE | Employee (plan) Service code 30 | 32 BAY 17TH STREET BROOKLYN, NY 11214 | $55K |
| PRAGER MATIS CPAS, LLC EIN 06-1667465 NONE | Accounting (including auditing) Service code 10 | 100 SUNNYSIDE BLVD SUITE 200 WOODBURY, NY 11797 | $51K |
| KATHY MONGELLO EIN 11-1708617 WIFE-JOHN MONGELLO | Employee (plan) Service code 30 | 115 TOPAZ DRIVE FREEHOLD, NJ 07728 | $34K |
| MULTIPLAN, INC EIN 13-3068979 NONE | Contract Administrator Service code 13 | PO BOX 29395 GPO NEW YORK, NY 100879395 | $29K |
| GENERAL VISION SERVICES, LLC EIN 11-3580576 NONE | Contract Administrator; Claims processing Service code 12 | 520 EIGHTH AVENUE STE 901 NEW YORK, NY 10018 | $26K |
| STARR, GERN, DAVISON & RUBIN PC EIN 22-3241223 AFFILIATED UNION ATTORNEY | Legal Service code 29 | 105 EISENHOWER PARKWAY SUITE 401 ROSELAND, NJ 070681640 | $16K |
| DDI CONSULTING SERVICES EIN 22-3627411 NONE | Consulting (general) Service code 16 | 221 SOMERVILLE ROAD BEDMINSTER, NJ 07921 | $13K |
| UCG TECHNOLOGIES EIN 34-1566988 NONE | Other services; Consulting (general) Service code 16 | 1700 E PLEASANT VALLEY ROAD STE 250 INDEPENDENCE, OH 44131 | $11K |
| PAYCHEX EIN 16-1124166 NONE | Other fees Service code 99 | 102 MOTOR PKWY SUITE 300 HAUPPAUGE, NY 11788 | $8K |
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 | 650 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 651 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMBLEMHEALTH | 76 | $1.1M |
| Dental(2 contracts) | HEALTHPLEX | 395 | $179K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 113 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 395 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.