| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY EASTERN STATES | 333 WEST 34TH STREET NEW YORK, NY 10001 | EVEREST REINSURANCE COMPANY | $30K | — | $30K | 5.00% |
| COMBINED DBL RESOURCES LTD3 | 555 BROADHOLLOW ROAD MELVILLE, NY 11747 | SHELTERPOINT LIFE INSURANCE CO. | $3K | — | $3K | 12.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC. EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 3 PENN PLAZA NEWARK, NJ 07105 | $636K |
| SLEVIN & HART P.C. EIN 52-1708613 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 1625 MASSACHUSETTS AVENUE NW SUITE 450 WASHINGTON, DC 20036 | $190K |
| ROSALBA PEREZ-PENA EIN 13-1564856 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $171K |
| WAGNER & ZWERMAN LLP EIN 11-2836481 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | 450 WIRELESS BLVD HAUPPAUGE, NY 11788 | $79K |
| RAMONA AYBAR EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $64K |
| LOUVINIA GREENAWAY EIN 13-1564856 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $56K |
| VISION SCREENING EIN 11-2358021 CLAIMS PROCESSING | Direct payment from the plan; Claims processing Service code 12 | 1919 MIDDLE COUNTRY ROAD CENTEREACH, NY 11720 | $50K |
| VEDWATIE PRASAD EIN 13-1564856 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $49K |
| NELSY RODRIGUEZ EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $38K |
| JEAN EDY JOSEPH EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $37K |
| PIERRE J. BOUTIN EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $36K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 3 SURREY LANE HEMPSTEAD, NY 11550 | $31K |
| THE SEGAL COMPANY, INC. EIN 13-1835864 ACTUARIAL | Direct payment from the plan; Consulting (general); Actuarial Service code 11 | 333 WEST 34TH STREET NEW YORK, NY 10001 | $29K |
| BOSTON TRUST & INVESTMENT MANAGMENT EIN 04-2273811 INVESTMENT MANAGER | Direct payment from the plan; Investment management; Trustee (bank, trust company, or similar financial institution); Trustee (directed); Investment management fees paid directly by plan; Trustee (discretionary); Custodial (securities) Service code 19 | ONE BEACON STREET BOSTON, MA 02108 | $28K |
| CVS PHARMACY, INC. EIN 05-0340626 CLAIMS PROCESSING | Direct payment from the plan; Claims processing Service code 12 | 180 PASSAIC AVE FAIRFIELD, NJ 07004 | $21K |
| NEPC, LLC EIN 26-1429809 INVESTMENT ADVISORY | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | 255 STATE STREET BOSTON, MA 02109 | $8K |
| NATIONAL BENEFIT CONSULTANTS, INC. EIN 27-1024084 CONSULTING | Direct payment from the plan; Consulting (general) Service code 16 | 744 BROADWAY SUITE 200 BAYONNE, NJ 07002 | $8K |
| HERITAGE RX EIN 90-0768729 CONSULTING | Direct payment from the plan; Consulting (general) Service code 16 | 502 WASHINGTON AVENUE SUITE 725 TOWSON, MD 21204 | $8K |
| TPA CORPORATION EIN 13-3329882 COMPUTER CONSULTANT | Consulting (general); Direct payment from the plan; Consulting fees Service code 16 | 531 ROUTE 52 CARMEL, NY 10512 | $6K |
| AMALGAMATED BANK EIN 13-4920330 INVESTMENT CUSTODIAN | Custodial (securities); Investment management fees paid directly by plan Service code 19 | 275 7TH AVENUE NEW YORK, NY 10001 | $4K |
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 | 1,998 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts) | DENTCARE DELIVERY SYSTEMS | 1,619 | $354K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 1,945 | $99K |
| Long-term disability | SHELTERPOINT LIFE INSURANCE CO. | 352 | $27K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 1,736 | $593K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,945 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.