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 |
|---|---|---|---|
| BOON ADMINISTRATIVE SERVICES EIN 33-0449333 ADMINISTRATOR | Legal; Direct payment from the plan Service code 29 | 1508 WEST MOCKINGBIRD LANE DALLAS, TX 75235 | $387K |
| MAGNACARE ADMINISTRATIVE SVCS, LLC EIN 11-3410766 CLAIMS PROCESSING | Claims processing; Direct payment from the plan Service code 12 | 1600 STEWART AVENUE 7TH FLOOR WESTBURY, NY 11590 | $273K |
| PETER HASHO EIN 11-6490308 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 400 GARDEN CITY PLAZA SUITE 106 GARDEN CITY, NY 11530 | $166K |
| ROBERT M VELLA EIN 11-6490308 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | 400 GARDEN CITY PLAZA SUITE 106 GARDEN CITY, NY 11530 | $153K |
| USA RISK GROUP EIN 03-0288384 CAPTIVE MANAGER | Legal; Direct payment from the plan Service code 29 | 307 FALLS STREET SUITE A GREENVILLE, SC 29601 | $83K |
| RICHARD DOMBROWSKI EIN 11-6490308 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 400 GARDEN CITY PLAZA SUITE 106 GARDEN CITY, NY 11530 | $61K |
| MERRILL LYNCH EIN 13-5674085 INVESTMENT CUSTODIAN | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | ONE CROSSROADS DRIVE, BLDG ONE BEDMINSTER, NJ 07921 | $54K |
| ADELA LUTZ EIN 11-6490308 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 400 GARDEN CITY PLAZA SUITE 106 GARDEN CITY, NY 11530 | $51K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 LEGAL | Legal; Direct payment from the plan Service code 29 | 3 SURREY LANE HEMPSTEAD, NY 11550 | $36K |
| PERRY SCALZA EIN 11-6490308 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 400 GARDEN CITY PLAZA SUITE 106 GARDEN CITY, NY 11530 | $33K |
| AMERICAN HEALTH CARE EIN 68-0146015 CLAIMS PROCESSING | Claims processing; Direct payment from the plan Service code 12 | 3850 ATHERTON ROAD ROCKLIN, CA 95765 | $26K |
| WAGNER & ZWERMAN LLP EIN 11-2836481 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | 201 OLD COUNTRY ROAD SUITE 202 MELVILLE, NY 11747 | $21K |
| SUMMIT ACTUARIAL SERVICES EIN 20-3838633 ACTUARIAL | Actuarial; Direct payment from the plan Service code 11 | 123 PREAKNESS DRIVE MOUNT LAUREL, NJ 08054 | $11K |
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 | 2,299 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 2,299 | 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.