| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 333 WEST 34TH STREET NEW YORK, NY 10001 | THE UNION LABOR LIFE INSURANCE COMPANY | $52K | — | $52K | 6.20% |
| THE DBL CENTER LTD3 Filed as: DBL CENTER LTD | 155 PINELAWN ROAD, SUITE 120S MELVILLE, NY 11747 | SHELTERPOINT LIFE INSURANCE CO. | $7K | — | $7K | 7.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE INSURANCE CO. EIN 36-2739571 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 185 ASYLUM STREET HARTFORD, CT 06103 | $841K |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 900 COTTAGE GROVE RD BLOOMFIELD, CT 06002 | $205K |
| ROSALBA PEREZ EIN 13-1564856 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $189K |
| HORIZON HEALTHCARE SERVICES, INC. EIN 22-0999690 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | 3 PENN PLAZA NEWARK, NJ 07105 | $163K |
| SLEVIN & HART P.C. EIN 52-1708613 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 1625 MASSACHUSETTS AVE NW, STE 450 WASHINGTON, DC 20036 | $112K |
| RAMONA AYBAR EIN 13-6367793 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $73K |
| VEDWATIE PRASAD EIN 13-1564856 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $69K |
| LOUVINIA GREENAWAY EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $69K |
| WAGNER & ZWERMAN LLP EIN 11-2836481 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | 201 OLD COUNTRY ROAD, STE 202 MELVILLE, NY 117472731 | $69K |
| 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 | $63K |
| JEAN EDY JOSEPH EIN 13-1564856 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $58K |
| FLORMARIA GONZALEZ EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $57K |
| THE SEGAL COMPANY, INC. EIN 13-1835864 ACTUARIAL | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | 333 WEST 34TH STREET NEW YORK, NY 10001 | $46K |
| NELSY RODRIGUEZ EIN 13-1564856 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $35K |
| VISION SCREENING EIN 11-2358021 CLAIMS PROCESSING | Direct payment from the plan; Claims processing Service code 12 | 1919 MIDDLE COUNTRY ROAD, SUITE 304 CENTEREACH, NY 11720 | $33K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 ATTORNEY | Legal; Direct payment from the plan Service code 29 | 3 SURREY LANE HEMPSTEAD, NY 11550 | $31K |
| CAROL ULLOA EIN 13-6367793 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 160 EAST UNION AVENUE EAST RUTHERFORD, NJ 07073 | $29K |
| CVS PHARMACY, INC. EIN 05-0340626 CLAIMS PROCESSING | Claims processing; Direct payment from the plan Service code 12 | 180 PASSAIC AVE FAIRFIELD, NJ 07004 | $28K |
| BOSTON TRUST & INVESMENT MANAGEMENT EIN 04-2273811 INVESTMENT MANAGER | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution); Trustee (discretionary); Custodial (securities); Investment management; Trustee (directed) Service code 19 | ONE BEACON STREET BOSTON, MA 02108 | $25K |
| 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 | $15K |
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 | 2,110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 2,110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 2 carriers) | DENTCARE DELIVERY SYSTEMS | 1,478 | $454K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 2,110 | $106K |
| Stop-loss / reinsurancereinsurance | THE UNION LABOR LIFE INSURANCE COMPANY | 1,598 | $835K |
| Other | SHELTERPOINT LIFE INSURANCE CO. | 290 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,110 | — |
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."
No prospect flags tripped on this filing.