| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | P.O. BOX 62939 VIRGINIA BEACH, VA 234662939 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $24 | $5K | 2.98% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INS SERVICES LLC | P.O. BOX 3716 NORFOLK, VA 235143716 | METROPOLITAN LIFE INSURANCE COMPANY | — | $3K | $3K | 1.97% |
| RONALD P. COHEN3 | 486 WILLIS AVENUE WILLISTON PARK, NY 11596 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 12.67% |
| HIRAM COHEN AND SON, INC.3 Filed as: HIRAM COHEN & SON INC | 486 WILLIS AVENUE WILLISTON PARK, NY 11596 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $473 | $473 | 3.61% |
| NMP PLANNING CO. INC3 | 118-35 QUEENS BLVD, SUITE 1230 FOREST HILLS, NY 11375 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $33 | — | $33 | 0.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $4.1M |
| VITECH SYSYTEMS GROUP EIN 13-3785492 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $122K |
| INTECH INVESTMENT MANAGEMENT LLC EIN 01-0614895 | Investment management fees paid directly by plan; Investment management Service code 28 | — | $118K |
| EXPRESS SCRIPTS EIN 22-3461740 | Contract Administrator; Direct payment from the plan; Claims processing; Other fees Service code 12 | — | $96K |
| PETER J. RUFFNER EIN 13-1545680 | Employee (plan) Service code 30 | — | $95K |
| ROGER ROSS EIN 13-1545680 | Employee (plan) Service code 30 | — | $84K |
| PRUDENTIAL RETIREMENT INS. ANNUITY EIN 06-1050034 | Custodial (other than securities); Investment management fees paid indirectly by plan; Custodial (securities) Service code 18 | — | $75K |
| LOUISE FURIO EIN 13-1545680 | Employee (plan) Service code 30 | — | $67K |
| THE SEGAL COMPANY EIN 13-1835864 | Actuarial; Insurance agents and brokers; Direct payment from the plan Service code 11 | — | $47K |
| RITA MESSINA EIN 13-1545680 | Employee (plan) Service code 30 | — | $47K |
| SEAN DRISCOLL EIN 13-1545680 | Employee (plan) Service code 30 | — | $42K |
| KEVIN J. DRISCOLL EIN 13-1545680 | Employee (plan) Service code 30 | — | $41K |
| WILLIAM TURNBULL EIN 13-1545680 | Employee (plan) Service code 30 | — | $39K |
| SEGAL ROGERSCASEY EIN 13-2466110 | Consulting fees; Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $35K |
| ULLICO CASUALTY GROUP EIN 13-2988846 | Insurance services; Direct payment from the plan; Insurance brokerage commissions and fees Service code 23 | — | $34K |
| FRANCES MCCANN EIN 13-1545680 | Employee (plan) Service code 30 | — | $29K |
| LAPADULA, CARLSON & CO. CPA EIN 65-0292391 | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $28K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 | Custodial (other than securities); Direct payment from the plan Service code 18 | — | $26K |
| JAMES C. WHITE EIN 13-1545680 | Employee (plan) Service code 30 | — | $26K |
| KEITH M. BLECHMAN EIN 46-3594048 | Other services; Direct payment from the plan Service code 49 | — | $23K |
| RICHARD S. BROOK EIN 11-2543273 | Legal; Direct payment from the plan Service code 29 | — | $20K |
| CHUBB & SON EIN 13-1963496 | Insurance brokerage commissions and fees; Insurance services; Direct payment from the plan Service code 23 | — | $19K |
| COLLERAN, O'HARA MILLS LLP EIN 13-2940050 | Legal; Direct payment from the plan Service code 29 | — | $14K |
| SCHULTHEIS & PANETTIERI LLP EIN 13-1577780 | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $9K |
| UNIVERSITY ORTHOPAEDICS, PC EIN 06-1309687 | Direct payment from the plan; Other services Service code 49 | — | $8K |
| ROBERTO G. COLANGELO MD PC EIN 11-3512330 | Other services; Direct payment from the plan Service code 49 | — | $6K |
| VERIZON BUSINESS NETWORK SERVICES EIN 13-2745892 | Direct payment from the plan; Other services Service code 49 | — | $5K |
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 | 2,456 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2,232 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 4,688 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 11,254 | $6.3M |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 2,396 | $181K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 2,396 | $181K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 11,254 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
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.