No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SELF-INSURED DENTAL SERVICES EIN 11-2995970 NONE | Plan Administrator; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 303 MERRICK ROAD LYNBROOK, NY 11563 | $52K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Actuarial Service code 11 | 1 PARK AVENUE NEW YORK, NY 10016 | $34K |
| SPIVAK LIPTON LLP EIN 13-3494495 NONE | Legal Service code 29 | 1700 BROADWAY NEW YORK, NY 10019 | $26K |
| KOBGO ASSOCIATES, INC EIN 13-2751089 NONE | Accounting (including auditing) Service code 10 | 3 PARK AVENUE 14TH FLOOR NEW YORK, NY 10016 | $21K |
| GOULD, KOBRICK & SCHLAPP P.C. EIN 13-3082707 NONE | Accounting (including auditing) Service code 10 | 3 PARK AVENUE 14TH FLOOR NEW YORK, NY 10016 | $18K |
| STACEY BRAUN EIN 13-2889432 NONE | Investment management Service code 28 | 377 BROADWAY NEW YORK, NY 10013 | $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 | 211 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | EMBLEM HEALTH | 53 | $492K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 92 | $4K |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 92 | $330 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 92 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.