| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ALLAN MENDELS3 | 97 POWERHOUSE ROAD SUITE 104 ROSLYN HEIGHTS, NY 11577 | NATIONWIDE LIFE INSURANCE COMPANY | $40K | — | $40K | 18.22% |
| GEORGE XANTHAKY3 | 175 CENTERPORT ROAD CENTERPORT, NY 11590 | NATIONWIDE LIFE INSURANCE COMPANY | $40K | — | $40K | 18.22% |
| INTERNATIONAL BENEFITS ADMIN5 | 100 GARDEN CITY PLAZA SUITE 102 GARDEN CITY, NY 11530 | NATIONWIDE LIFE INSURANCE COMPANY | $32K | — | $32K | 14.77% |
| EMERSON REID LLC3 Filed as: EMERSON REID | 400 POST AVENUE SUITE 210 WESTBURY, NY 11590 | NATIONWIDE LIFE INSURANCE COMPANY | $8K | — | $8K | 3.88% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 HEALTH NETWORK PROVIDER | Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | 165 BROADWAY NEW YORK, NY 10006 | $44K |
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 | 139 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 139 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | NATIONWIDE LIFE INSURANCE COMPANY | 139 | $217K |
| Dental | NATIONWIDE LIFE INSURANCE COMPANY | 139 | $217K |
| Stop-loss / reinsurancereinsurance | NATIONWIDE LIFE INSURANCE COMPANY | 139 | $217K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.