No insurance carriers on this filing. Self-funded welfare plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC EIN 23-7391136 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Other services Service code 12 | — | $773K |
| SUSAN BRENARD EIN 11-1740492 RELATED TO PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $244K |
| ARTHUR ORZANO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $201K |
| FARLEY KAMHI EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $200K |
| BASYS, INC. EIN 52-1796473 NONE | Consulting (general); Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $186K |
| KEVIN ODONNELL EIN 11-1896570 SVCS TO RLTD PLN & UNION | Direct payment from the plan; Employee (plan) Service code 30 | — | $178K |
| DAVID LIEBERMAN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $177K |
| PROSKAUER ROSE LLP EIN 13-1840454 SERVICES TO RELATED UNION | Legal Service code 29 | — | $156K |
| ELIZABETH FORTE EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $132K |
| JACQUELINE SACHER EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $123K |
| CANDICE STARK EIN 11-1896570 SVCS TO RLTD PLN & UNION | Direct payment from the plan; Employee (plan) Service code 30 | — | $122K |
| RAVINDRAN KUTTALIL EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $114K |
| ANDRE WILLIAMS EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $108K |
| WAYNE SMITH EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $105K |
| JOSEPH MALONEY EIN 11-1896570 SVCS TO RLTD PLN & UNION | Direct payment from the plan; Employee (plan) Service code 30 | — | $104K |
| LINDA SCARSELLA EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $96K |
| ROSALIE HENRY EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $94K |
| ALEXIS MICHELMAN EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $93K |
| JOSEPH HAWLADER EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $87K |
| JOSE COLLADO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $85K |
| MASSAPEQUA ORAL & MAX LLP EIN 11-2998357 NONE | Direct payment from the plan Service code 50 | — | $84K |
| IVAN NIEVES EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $84K |
| KIM NGUYEN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $82K |
| STEPHANIE SARANITI EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $80K |
| MARIELA RUSSELL-GORE EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $80K |
| SANDRA MONAHAN EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $78K |
| ROOPKUMAR LACHMAN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $76K |
| DAISY PEREZ EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $74K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 NONE | Consulting (general) Service code 16 | — | $71K |
| JACQUELINE LUMSDEN-GRAHAM EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $71K |
| LILLIAN OLIVO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $71K |
| CHANNA JAYATILAKA EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $70K |
| JANE COSTANTINO EIN 11-1740492 SRVS TO RELATED PLAN | Employee (plan); Direct payment from the plan Service code 30 | — | $68K |
| GOULD, KOBRICK & SCHLAPP EIN 11-3082707 NONE | Accounting (including auditing) Service code 10 | — | $65K |
| CYNOMYS INC. EIN 22-3007300 NONE | Actuarial Service code 11 | — | $64K |
| JANET MASTROPOLO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $63K |
| WILLA WILSON-JONES EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $63K |
| NADAV SEGAL EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $63K |
| EDITH PAULINO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $61K |
| JAEMIN KWAK EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $60K |
| PRUDENTIAL TRUST CO. EIN 52-1679020 NONE | Investment management; Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $58K |
| ANA SOLORZANO EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $58K |
| ANA OLTENEAU EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $57K |
| EPLAN LLC NONE | Other services Service code 49 | 22601 N 19TH AVE 24 PHOENIX, AZ 85027 | $56K |
| RAUL ORTIZ EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
| JODI CIOFFI EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
| MEGAN SHEMANSKI EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
| JOSE BORIA EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $54K |
| NANCY TARNATE EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $53K |
| VALERIE BERMUDEZ EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $52K |
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 | 4,007 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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."
Self-funded plan with no stop-loss carrier attached. Catastrophic-risk exposure; stop-loss specialist sales target.