| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE BENEFIT SOLUTIONS INC3 Filed as: EMPLOYEE BENEFIT SOLUTIONS, LLC | 47 OLD RIDGEFIELD ROAD WILTON, CT 06897 | STANDARD SECURITY LIFE INSURANCE CO. OF NY | $46K | — | $46K | 17.65% |
| INVESTORS MUTUAL AGENCY INC3 Filed as: INVESTORS STRATEGY CORPORATION | 670 WHITE PLAINS ROAD SCARSDALE, NY 10583 | SUN LIFE AND HEALTH INSURANCE COMPANY | $16K | — | $16K | 14.84% |
| THE JEM AGENCY LLC3 | 50 WINDMILL ROAD ARMONK, NY 10504 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5K | $443 | $5K | 9.30% |
| JAY Z GERLITZ & ASSOCIATES INC.3 | 207 BRIARWOOD DRIVE SOMERS, NE 10589 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4K | — | $4K | 6.22% |
| BARBARA MOSCHELLA3 | 2 LAKE SOMERSET COURT BLUFFTON, SC 29909 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2K | — | $2K | 3.11% |
| BRAD BIEL3 | 2 GOLD STREET NEW YORK, NE 10038 | THE PAUL REVERE LIFE INSURANCE COMPANY | $865 | — | $865 | 1.48% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL R. ACKERMAN | 150 E. SWEDESFORD RD. WAYNE, PA 19087 | THE PAUL REVERE LIFE INSURANCE COMPANY | $108 | — | $108 | 0.19% |
| WENDY BIEL3 | COLONIAL LIFE AND ACCIDENT MT. FREEDOM, NJ 07970 | THE PAUL REVERE LIFE INSURANCE COMPANY | $97 | — | $97 | 0.17% |
| JAMEL WRIGHT3 | 341 MIDWOOD STREET BROOKLYN, NY 11225 | THE PAUL REVERE LIFE INSURANCE COMPANY | $31 | — | $31 | 0.05% |
| LINDSAY JEAN WALTERS3 | 2 GOLD STREET NEW YORK, NY 10038 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | — | $16 | 0.03% |
| WILLIAM E GOOD3 Filed as: WILLIAM E. GOOD | 2799 FLOWING SPRINGS ROAD SPRING CITY, PA 19475 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | — | $3 | 0.01% |
| HJM GROUP, INC.3 Filed as: HJM GROUP INC. | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $7K | — | $7K | 15.11% |
| THE JEM AGENCY LLC3 | 50 WINDMILL ROAD ARMONK, NY 10504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $139 | $2K | 11.11% |
| BRAD BIEL3 | 2 GOLD STREET NEW YORK, NY 10038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $196 | $801 | $997 | 6.65% |
| JAY Z GERLITZ & ASSOCIATES INC.3 Filed as: JAY Z. GERLITZ & ASSOCIATES INC. | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $500 | — | $500 | 3.34% |
| WENDY BIEL3 | 1257 CROSSBILL CT. WESTON, FL 33327 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | — | $20 | 0.13% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL R. ACKERMAN | 150 E. SWEDESFORD RD. WAYNE, PA 19087 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.09% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Float revenue Service code 12 | — | $159K |
| JAY Z GERLITZ & ASSOCIATES INC. NONE | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | $23K |
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 | 287 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 288 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | STANDARD SECURITY LIFE INSURANCE CO. OF NY | 206 | $263K |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 205 | $0 |
| Vision | AMERICAN GENERAL LIFE INSURANCE COMPANY | 141 | $45K |
| Life insurance(3 contracts, 3 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 264 | $184K |
| Short-term disability(3 contracts, 3 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 264 | $184K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 264 | $111K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 205 | $0 |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INSURANCE CO. OF NY | 206 | $263K |
| Other(3 contracts, 3 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 264 | $184K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 264 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.