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 | Float revenue; Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $797K |
| SUSAN BRENARD EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $359K |
| BASYS, INC. EIN 52-1796473 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Consulting (general) Service code 15 | — | $284K |
| ARTHUR ORZANO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $255K |
| FARLEY KAMHI EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $222K |
| KEVIN ODONNELL EIN 11-1896570 SVCS TO RLTD PLN & UNION | Employee (plan); Direct payment from the plan Service code 30 | — | $207K |
| DAVID LIEBERMAN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $205K |
| ELIZABETH FORTE EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $152K |
| JOSEPH MALONEY EIN 11-1896570 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $148K |
| JAEMIN KWAK EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $146K |
| ANDRE WILLIAMS EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $144K |
| WAYNE SMITH EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $127K |
| ROSALIE HENRY EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $108K |
| JACQUELINE SACHER EIN 11-1740492 SVCS TO RLTD PLN & UNION | Direct payment from the plan; Employee (plan) Service code 30 | — | $107K |
| LINDA SCARSELLA EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $106K |
| STEPHANIE SARANITI EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $102K |
| KIM NGUYEN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $100K |
| JOSEPH HAWLADER EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $99K |
| AKIM WILLIAMS EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $98K |
| EPLAN LLC NONE | Other services Service code 49 | 22601 N 19TH AVE 24 PHOENIX, AZ 85027 | $97K |
| MARIELA RUSSELL-GORE EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $96K |
| JOSE COLLADO EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $93K |
| IVAN NIEVES EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $88K |
| ALEXIS MICHELMAN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $87K |
| AMPARO ZOUROS EIN 11-1740492 NONE | Direct payment from the plan Service code 50 | — | $85K |
| MASSAPEQUA ORAL & MAX LLP EIN 11-2998357 NONE | Direct payment from the plan Service code 50 | — | $84K |
| ROOPKUMAR LACHMAN EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $82K |
| DAISY PEREZ EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| SANDRA MONAHAN EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $80K |
| CHANNA JAYATILAKA EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $79K |
| LILLIAN OLIVO EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| CYNOMYS INC. EIN 82-2668930 NONE | Actuarial Service code 11 | — | $76K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 NONE | Consulting (general) Service code 16 | — | $76K |
| JACQUELINE LUMSDEN-GRAHAM EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $74K |
| JANET MASTROPOLO EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $73K |
| JANE COSTANTINO EIN 11-1740492 SRVS TO RELATED PLAN | Employee (plan); Direct payment from the plan Service code 30 | — | $71K |
| JODI CIOFFI EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $67K |
| EDITH PAULINO EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $66K |
| GOULD, KOBRICK & SCHLAPP EIN 11-3082707 NONE | Accounting (including auditing) Service code 10 | — | $65K |
| PRUDENTIAL TRUST CO. EIN 52-1679020 NONE | Investment management; Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $63K |
| ANA SOLORZANO EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $63K |
| MEGAN SHEMANSKI EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $63K |
| MANDY REACH EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $63K |
| KATRINA GRAHAM EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $62K |
| ANA OLTENEAU EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $62K |
| NANCY TARNATE EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $59K |
| RAUL ORTIZ EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $59K |
| VALERIE BERMUDEZ EIN 11-1740492 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $59K |
| NADAV SEGAL EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $59K |
| MAUVALIN JACQUES EIN 11-1740492 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
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 | 4,149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 23 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,172 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.