| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMERICAN CORP BENEFITS INC3 | 62 WILLIAM STREET 4TH FLOOR NEW YORK, NY 10005 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $37K | $0 | $37K | 9.43% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, LLC EIN 47-0854646 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $925K |
| DELTA DENTAL OF NEW YORK, INC. EIN 11-1980218 TPA | Contract Administrator Service code 13 | — | $36K |
| EBPA LLC TPA | Contract Administrator Service code 13 | P.O. BOX 2365 SOUTH BURLINGTON, VT 05407 | $30K |
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 | 3,166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 21 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,187 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW YORK, INC. | 580 | $195K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK | 1,579 | $1.4M |
| Life insurance | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | 1,139 | $392K |
| Stop-loss / reinsurancereinsurance | UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK | 1,579 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,579 | — |
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.