| 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 YROK, NY 10001 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 1.32% |
| 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% |
| 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 | — | $13K | $13K | 10.01% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (EASTERN STATES) | 333 WEST 34TH STREET NEW YORK, NY 10001 | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | $747 | — | $747 | 11.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INS. CO (CIGNA) EIN 59-1031071 NONE | Direct payment from the plan; Float revenue; Other services; Contract Administrator; Participant communication; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $686K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 NONE | Contract Administrator; Direct payment from the plan; Participant communication; Claims processing; Plan Administrator Service code 12 | — | $29K |
| DELTA DENTAL OF NEW YORK, INC. EIN 11-1908021 NONE | Direct payment from the plan; Plan Administrator; Claims processing Service code 12 | — | $0 |
| MATRIX ABSENCE MANAGEMENT, INC. EIN 77-0493584 NONE | Claims processing 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 | 1,261 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Beneficiaries receiving benefits | 2 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,279 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GEISINGER HEALTH PLAN | 131 | $1.2M |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INS. CO. OF NY | 2,302 | $130K |
| Life insurance | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,230 | $371K |
| Short-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 103 | $7K |
| Long-term disability | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,149 | $281K |
| Prescription drug | GEISINGER HEALTH PLAN | 131 | $1.2M |
| Stop-loss / reinsurancereinsurance | GARDEN STATE LIFE INSURANCE COMPANY | 1,084 | $567K |
| Other | FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY | 103 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,302 | — |
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.