| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GARY LEVINE AND ASSOCIATES LTD3 | 350 MOTOR PARKWAY SUITE 404 HAUPPAUGE, NY 11788 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $25K | $3K | $28K | 3.39% |
| DONALD C SAVOY INC3 | 25B HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $9K | — | $9K | 1.13% |
| GARY LEVINE AND ASSOCIATES LTD3 | 350 MOTOR PARKWAY SUITE 404 HAUPPAUGE, NY 11788 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $413 | — | $413 | 0.05% |
| DONALD C SAVOY INC3 | 25B HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $83 | — | $83 | 0.01% |
| GARY LEVINE AND ASSOCIATES LTD3 | 350 MOTOR PARKWAY SUITE 404 HAUPPAUGE, NY 11788 | EMPIRE HEALTHCHOICE ASSURANCE INC. | $3K | — | $3K | 5.00% |
| DONALD C SAVOY INC3 | 25B HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | EMPIRE HEALTHCHOICE ASSURANCE INC. | $3K | — | $3K | 4.87% |
| SAVOY ASSOCIATES3 Filed as: DONALD C SAVOY T/A SAVOY ASSOCIATES | 25B HANOVER ROAD SUITE 220 FLORHAM PARK, NJ 07932 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $307 | — | $307 | 4.83% |
No Schedule C service providers reported on this filing.
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 | 173 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 175 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | EMPIRE HEALTHCHOICE ASSURANCE INC. | 56 | $52K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC | 62 | $826K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 173 | $6K |
| Other | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 173 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.