| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SOLID BENEFIT GUIDANCE3 | 85 CHESTNUT RIDGE ROAD, SUITE 214 MONTVALE, NJ 07645 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $260K | — | $260K | 2.74% |
| BLASCH JOHN3 | 71 BEECHWOOD LANE BERKELEY HEIGHTS, NJ 07922 | THE HARTFORD LIFE INSURANCE COMPANY | $5K | $1K | $7K | 25.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KMR SYSTEMS CORP EIN 13-3192128 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $185K |
| MARSHALL & MOSS,PAYROLL COMPLIANCE EIN 04-3652965 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $157K |
| MELISSA VELAZQUEZ EIN 13-3562352 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $86K |
| ZAIDA DE LA CRUZ EIN 13-3562352 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| MARSHALL & MOSS,LLP EIN 11-3360166 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $70K |
| BARNES, IACCARINO, & SHEPPARD NONE | Legal; Direct payment from the plan Service code 29 | 258 SAW MILL RIVER PKWY NEW YORK, NY 10038 | $51K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $45K |
| SLEVIN & HART P.C. NONE | Legal; Direct payment from the plan Service code 29 | 1625 MASSACHUSETTS AVE. NW 450 WASHINGTON, DC 20036 | $41K |
| REINA-LYNN GIORDANO EIN 13-3562352 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $34K |
| NOVAK FRANCELLA, LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $32K |
| AMALGAMATED BANK OF NY EIN 13-4920330 NONE | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $23K |
| ADMINISTRATIVE SERVICES ONLY, INC. NONE | Contract Administrator; Direct payment from the plan Service code 13 | 303 MERRICK RD 300 LYNBROOK, NY 11563 | $22K |
| LOCAL 8A-28A WELFARE EIN 13-5624028 NONE | Other services; Direct payment from the plan Service code 49 | — | $19K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $16K |
| LOCKTIGHT SOLUTIONS NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 2166 BROADWAY SUITE 17D NEW YORK, NY 10024 | $10K |
| METROPOLITAN MANAGEMENT SRVCS, INC. NONE | Direct payment from the plan; Consulting (general) Service code 16 | 5TH AVE. NEW YORK, NY 10123 | $9K |
| SEGAL ROGERSCASEY EIN 13-2646110 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $5K |
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 | 1,033 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 31 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,064 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE UNION LABOR LIFE INSURANCE COMPANY | 642 | $557K |
| Life insurance(2 contracts, 2 carriers) | THE HARTFORD LIFE INSURANCE COMPANY | 676 | $41K |
| Other(2 contracts, 2 carriers) | THE HARTFORD LIFE INSURANCE COMPANY | 676 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,944 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.