No insurance carriers on this filing. Self-funded welfare plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COHEN WEISS & SIMON LLP ATTORNEY | Legal; Direct payment from the plan Service code 29 | 900 3RD AVE 21TH FL NEW YORK, NY 10022 | $167K |
| MAGNACARE ADMINISTRATIVE SERVICES EIN 11-3410766 PROCESSING MANAGER | Claims processing; Direct payment from the plan Service code 12 | 1600 STEWART AVENUE WESTBURY, NY 11090 | $93K |
| VAL EDWARDS EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 860 E. 228TH ST NEW YORK, NY 10466 | $84K |
| ISMAEL TORRES EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 80 AEDEN ST. APT3E NEW YORK, NY 10040 | $72K |
| LAVETTE S. MORGAN-SMYER EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 196-05 119TH AVENUE ST.ALBANS, NY 11412 | $66K |
| JM PENSION ADVISORY INC NONE | Direct payment from the plan; Consulting (general) Service code 16 | 3905 NATIONAL DR STE 375 BURTONSVILLE, MD 20866 | $66K |
| DANIEL H. COOK ASSOCIATES, INC. EIN 11-2424843 NONE | Direct payment from the plan; Claims processing Service code 12 | 253 WEST 35TH ST 12TH FL NEW YORK, NY 10001 | $59K |
| CYNTHIA A LANG EIN 13-3505523 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 955 UNDERHILL AVE 2102 BRONX, NY 10473 | $58K |
| ACHRAF KAMEL EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 146 PETRUS AVENUE STATEN ISLAND, NY 10312 | $55K |
| SAVI THOMAS EIN 13-3505523 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 249-12 145TH AVE ROSEDALE, NY 11422 | $54K |
| SHARI S. KRAVITZ EIN 13-3505523 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 2020 KIMBALL ST BROOKLYN, NY 11234 | $53K |
| PROCARE PHARMACY BENEFIT MGR INC EIN 58-2422694 NONE | Claims processing; Direct payment from the plan Service code 12 | 3090 PREMIERE PKWY DULUTH, GA 30094 | $48K |
| ROGOFF & COMPANY P.C. EIN 13-2688836 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | 355 LEXINGTON AVE, 5TH FL NEW YORK, NY 10017 | $45K |
| FORD & HARRISON LLP EIN 58-1314995 ATTORNEY | Legal Service code 29 | 100 PARK AVE S STE 2500 NEW YORK, NY 10017 | $45K |
| SUMMIT ACTUARIAL SERVICES LLC EIN 20-3838633 ACTURIAL | Direct payment from the plan; Actuarial Service code 11 | 123 PREAKNESS DRIVE MOUNT LAUREL, NJ 08054 | $36K |
| SEGAL ADVISORS INC INVESTMENT ADVISOR | Investment advisory (plan); Direct payment from the plan Service code 27 | 333 WEST 34TH STREET 5TH FL NEW YORK, NY 10001 | $35K |
| ANGELA TRUONG EIN 13-3505523 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 658 FLUSHING AVE 1 BROOKLYN, NY 11206 | $30K |
| MARIA REYES DOMINGUEZ EIN 13-3505523 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 115 VERMILYEA AVENUE APT4D NEW YORK, NY 10034 | $30K |
| LUISA SIERRA EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1560 150TH STREET 2 WHITESONE, NY 11357 | $29K |
| JOSEPH F. HARNOS EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 101 HARRIET RD NORTH BABYLON, NY 11703 | $25K |
| CHUNG HOK LEUNG EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 64-06 ELLWELL CRSCNT REGO PARK, NY 11374 | $20K |
| SIGIFREDO LOPEZ EIN 13-3505523 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 41-44 44TH STREET APT F12 SUNNYSIDE, NY 11104 | $13K |
| TAHIA KHALIL EIN 13-3505523 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 2885 WEST 12TH ST BROOKLYN, NY 11224 | $13K |
| VITECH SYSTEMS GROUP INC EIN 13-3785492 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 401 PARK AVE S 12TH FL NEW YORK, NY 10016 | $12K |
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 | 1,684 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,684 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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."
Self-funded plan with no stop-loss carrier attached. Catastrophic-risk exposure; stop-loss specialist sales target.