| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GROUP BENEFIT ADM CT INC3 | 23 MAIDEN LANE NORH HAVEN, CT 06473 | ANTHEM HEALTH PLANS, INC | $5K | — | $5K | 1.95% |
| GFS INC3 Filed as: GFS, INC | 23 MAIDEN LANE NORTH HAVEN, CT 06473 | ANTHEM HEALTH PLANS, INC | $560 | — | $560 | 0.24% |
| JEFFREY CHAPMAN3 | 308 MALTBIE ST, STE 101 SYRACUSE, NY 13204 | HARTFORD LIFE AND ACCIDENT | $15K | — | $15K | 8.00% |
| GROUP BENEFIT ADM CT INC3 | — | ANTHEM HEALTH PLANS, INC | $2K | — | $2K | 2.64% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA INC EIN 06-6033492 NONE | Contract Administrator; Claims processing Service code 12 | — | $253K |
| RICHARD PAGANO EIN 13-3319782 NONE | Employee (plan) Service code 30 | — | $96K |
| SULLIVAN WARD ASHER & PATTON PC EIN 38-1880608 NONE | Legal Service code 29 | — | $85K |
| PLANTE & MORAN, PLLC EIN 38-1357951 NONE | Accounting (including auditing) Service code 10 | — | $83K |
| TONYA FELTON EIN 13-3319782 NONE | Employee (plan) Service code 30 | — | $61K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Accounting (including auditing) Service code 10 | — | $39K |
| SCHULTHEIS & PANETTIERI LLP EIN 13-1577780 NONE | Accounting (including auditing) Service code 10 | — | $30K |
| YUCATECH INC EIN 20-2390560 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $29K |
| HEALTH DECISIONS INC EIN 38-2686266 NONE | Consulting fees Service code 70 | — | $29K |
| EMPIRE HEALTHCHOICE HMO, INC EIN 13-3874803 NONE | Contract Administrator; Claims processing Service code 12 | — | $23K |
| SELE-DENT INC EIN 11-3310187 NONE | Claims processing; Contract Administrator Service code 12 | — | $18K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 NONE | Other fees; Other services; Custodial (securities); Investment advisory (plan) Service code 19 | — | $17K |
| ANTHEM HEALTH PLANS, INC EIN 06-1475928 NONE | Claims processing; Contract Administrator Service code 12 | — | $15K |
| EXPRESS SCRIPTS, INC EIN 22-3461740 NONE | Claims processing Service code 12 | — | $15K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | — | $12K |
| LOWER HUDSON VALLEY EAP EIN 13-3240307 NONE | Contract Administrator; Claims processing Service code 12 | — | $12K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Actuarial Service code 11 | — | $9K |
| H.J. KNIGHT INTERNATIONAL EIN 04-2960092 NONE | Insurance services Service code 23 | — | $8K |
| MORGAN STANELY SMITH BARNEY LLC | Other fees; Other services Service code 49 | — | $0 |
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 | 516 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 316 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 832 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | EMPIRE HEALTHCHOICE HMO, INC. | 61 | $1.0M |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 837 | $185K |
| Prescription drug | EMPIRE HEALTHCHOICE HMO, INC. | 61 | $691K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 515 | $119K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 837 | $185K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 837 | — |
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.