| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (EASTERN STATES) | 333 WEST 34TH STREET 3RD FLOOR NEW YORK, NY 10001 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $14K | — | $14K | 5.00% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (EASTERN STATES) | 333 WEST 34TH STREET 3RD FLOOR NEW YROK, NY 10001 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 3.07% |
| SIBSON CONSULTING3 | 333 WEST 34TH STREET 3RD FLOOR NEW YORK, NY 10001 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. CO. OF NY | $12K | — | $12K | 8.46% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (EASTERN STATES) | 333 WEST 34TH STREET NEW YORK, NY 10001 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INS. CO. EIN 59-1031071 NONE | Float revenue; Claims processing; Participant communication; Other services; Named fiduciary; Non-monetary compensation; Direct payment from the plan; Contract Administrator Service code 12 | — | $632K |
| DELTA DENTAL OF NEW YORK, INC. EIN 11-1908021 NONE | Plan Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $38K |
| MATRIX ABSENCE MANAGEMENT, INC. EIN 77-0493584 NONE | Claims processing Service code 12 | — | $24K |
| CIGNA | Contract Administrator; Claims processing; Non-monetary compensation; Participant communication; Other services; Named fiduciary; Direct payment from the plan; Float revenue Service code 12 | — | $0 |
| CIGNA (HEALTHY REWARD VENDORS) | Participant communication; Named fiduciary; Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Other services Service code 12 | — | $0 |
| CIGNA (HEALTHY REWARDS VENDOR) | Participant communication; Named fiduciary; Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Other services Service code 12 | — | $0 |
| CIGNA (HEALTHY REWARDS VENDORS) | Participant communication; Contract Administrator; Float revenue; Other services; Claims processing; Direct payment from the plan; Named fiduciary; Non-monetary compensation Service code 12 | — | $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 | 1,244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,255 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | GEISINGER HEALTH PLAN | 2,500 | $1.3M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. CO. OF NY | 2,346 | $143K |
| Life insurance | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,191 | $167K |
| Short-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 45 | $3K |
| Long-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,132 | $279K |
| Prescription drug | GEISINGER HEALTH PLAN | 172 | $1.3M |
| Stop-loss / reinsurancereinsurance | TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY | 978 | $577K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,500 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.