| 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 | $49K | — | $49K | 17.65% |
| INVESTORS MUTUAL AGENCY INC3 Filed as: INVESTORS STRATEGY CORPORATION | 670 WHITE PLAINS ROAD SCARSDALE, NY 10583 | SUN LIFE AND HEALTH INSURANCE COMPANY | $18K | — | $18K | 15.00% |
| THE JEM AGENCY LLC3 | 50 WINDMILL ROAD ARMONK, NY 10504 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4K | $45 | $4K | 6.92% |
| JAY Z GERLITZ & ASSOCIATES INC.3 | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 5.30% |
| BARBARA MOSCHELLA3 | 2 LAKE SOMERSET COURT BLUFFTON, SC 29909 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | — | $1K | 2.36% |
| BRAD BIEL3 | 1050 WALL STREET WEST LYNDHURST, NJ 07071 | THE PAUL REVERE LIFE INSURANCE COMPANY | $801 | $58 | $859 | 1.39% |
| BRYLIN EMPLOYEE BENEFITS LLC3 | 37 PONDVIEW DRIVE ALLENTOWN, NJ 08501 | THE PAUL REVERE LIFE INSURANCE COMPANY | $153 | $7 | $160 | 0.26% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL R. ACKERMAN | 435 DEVON PARK DR STE 410 WAYNE, PA 19087 | THE PAUL REVERE LIFE INSURANCE COMPANY | $83 | — | $83 | 0.13% |
| WENDY BIEL3 | 1257 CROSSBILL CT WESTON, FL 33327 | THE PAUL REVERE LIFE INSURANCE COMPANY | $82 | — | $82 | 0.13% |
| JAMEL WRIGHT3 | 1517 RIVERSIDE STATION BLVD SECAUCUS, NJ 07094 | THE PAUL REVERE LIFE INSURANCE COMPANY | $26 | — | $26 | 0.04% |
| WILLIAM E GOOD3 Filed as: WILLIAM E. GOOD | 311 BOWIE STREET AUSTIN, TX 78703 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | — | $3 | 0.00% |
| JAY Z GERLITZ & ASSOCIATES INC.3 Filed as: JAY Z. GERLITZ AND ASSOCIATES INC | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $2K | — | $2K | 8.49% |
| THE JEM AGENCY LLC3 | 50 WINDMILL ROAD ARMONK, NY 10504 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $11 | $1K | 7.35% |
| JAY Z GERLITZ & ASSOCIATES INC.3 Filed as: JAY Z. GERLITZ & ASSOCIATES INC. | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $487 | — | $487 | 3.43% |
| BRAD BIEL3 | 1050 WALL STREET WEST LYNDHURST, NJ 07071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $144 | $330 | $474 | 3.33% |
| TIMOTHY J REED3 | 21 AZALEA DRIVE LUMBERTON, NJ 08048 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | $4 | $22 | 0.15% |
| MICHAEL R ACKERMAN3 Filed as: MICHAEL R. ACKERMAN | 435 DEVON PARK DR STE 410 WAYNE, PA 19087 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.08% |
| JASON SCZEPANIAK3 Filed as: JASON C. SHAPIRO | 41 BRENTON STREET LITCHFIELD, NH 03052 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.08% |
| WENDY BIEL3 | 1257 CROSSBILL CT. WESTON, FL 33327 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.06% |
| THE WORKSIGHT GROUP LLC3 | 1050 WALL STREET WEST LYNDHURST, NJ 07071 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $1 | $2 | 0.01% |
| HJM GROUP, INC.3 Filed as: HJM GROUP INC. | 207 BRIARWOOD DRIVE SOMERS, NY 10589 | AMERICAN GENERAL LIFE INSURANCE COMPANY | $2K | — | $2K | 12.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Other fees; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $375K |
| JAY Z GERLITZ & ASSOCIATES INC. NONE | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers 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 | 245 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 245 | 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 | 216 | $280K |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 210 | $0 |
| Vision(2 contracts, 2 carriers) | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | 213 | $35K |
| Life insurance(3 contracts, 3 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 245 | $197K |
| Short-term disability(3 contracts, 3 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 245 | $197K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 245 | $120K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 210 | $0 |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INSURANCE CO. OF NY | 216 | $280K |
| Other(3 contracts, 3 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 245 | $197K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 245 | — |
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.