| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHARLES LEVINSOHN3 | 82 WHARFSIDE DR. MONMOUTH BEACH, NJ 07750 | DELTA DENTAL OF NEW YORK | $8K | — | $8K | 2.50% |
| PETER NUSSBAUM3 | 32 MIDDLEBROOK DR. OCEAN, NJ 07712 | DELTA DENTAL OF NEW YORK | $8K | — | $8K | 2.50% |
| HILB GROUP OF NEW ENGLAND3 Filed as: HILB GROUP OF NEW YORK | 1983 MARCUS AVE. LAKE SUCCESS, NY 11042 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $7K | $14K | 6.45% |
| CHARLES LEVINSOHN3 | 82 WHARFSIDE DR. MONMOUTH BEACH, NJ 07750 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 2.85% |
| PETER NUSSBAUM3 | 32 MIDDLEBROOK DR. OCEAN, NJ 07712 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 2.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LUMINARE HEALTH BENEFITS, INC EIN 35-1846036 CLAIMS ADMINISTRATOR | Claims processing; Plan Administrator; Other services Service code 12 | — | $139K |
| CIGNA EIN 59-1031071 CLAIMS ADMINISTRATOR | Other services; Claims processing Service code 12 | — | $86K |
| MULTIPLAN, INC. EIN 13-3068979 CLAIMS ADMINISTRATOR | Other services; Plan Administrator; Claims processing Service code 12 | — | $10K |
| CHANGE HEALTHCARE EIN 20-5716594 CLAIMS ADMINISTRATOR | Claims processing; Other services Service code 12 | — | $8K |
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 | 194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW YORK | 573 | $314K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 334 | $215K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 334 | $280K |
| Short-term disability | STANDARD SECURITY LIFE INSURANCE COMAPNY OF NEW YORK | 199 | $27K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 334 | $215K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | GRANULAR INSURANCE COMPANY | 285 | $1.1M |
| Other(4 contracts, 4 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 334 | $300K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 573 | — |
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."
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.