| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 333 W 34TH STREET, FLOOR 2 NEW YORK, NY 10001 | AETNA LIFE INSURANCE COMPANY | $54K | $16K | $70K | 1.61% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DEREK DAVIS EIN 13-2643045 NONE | Employee (plan) Service code 30 | — | $148K |
| ADMINISTRATIVE SERVICES ONLY, INC. EIN 11-2995970 NONE | Contract Administrator Service code 13 | — | $87K |
| KISHOR MANCHIKALAPATI EIN 13-2643045 NONE | Employee (plan) Service code 30 | — | $72K |
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 NONE | Accounting (including auditing) Service code 10 | — | $62K |
| DAWN NEDD EIN 13-2643045 NONE | Employee (plan) Service code 30 | — | $61K |
| SPIVAK LIPTON, LLP EIN 13-3494495 NONE | Legal Service code 29 | — | $60K |
| ALEJANDRA VEGA-ROJAS EIN 13-2643045 NONE | Employee (plan) Service code 30 | — | $52K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Consulting (general); Insurance brokerage commissions and fees Service code 16 | — | $42K |
| CHERYL DABRE EIN 13-2643045 NONE | Employee (plan) Service code 30 | — | $35K |
| GALLAGHER FIDUCIARY ADVISORS, LLC EIN 36-4291971 NONE | Investment advisory (plan) Service code 27 | — | $21K |
| MAYARA COLON EIN 13-2643045 NONE | Employee (plan) Service code 30 | — | $20K |
| JP MORGAN CHASE BANK N.A. EIN 13-4994650 NONE | Investment management; Custodial (securities) Service code 19 | — | $19K |
| PRITCHARD INDUSTRIES, INC. NONE | Other services Service code 49 | 1120 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | $8K |
| ADP, INC. EIN 13-3036745 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $8K |
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 | 4,497 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 4,497 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 581 | $4.4M |
| Dental | AETNA LIFE INSURANCE COMPANY | 581 | $4.4M |
| Vision | AETNA LIFE INSURANCE COMPANY | 581 | $4.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 581 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.