| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOHN H BLASCH3 | 71 BEECHWOOD LN BERKLEY HEIGHTS, NJ 07922 | SYMETRA LIFE INSURANCE COMPANY | $5K | — | $5K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE CO EIN 23-7391136 NONE | Insurance agents and brokers; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Insurance brokerage commissions and fees; Direct payment from the plan; Other commissions; Contract Administrator; Float revenue Service code 12 | — | $660K |
| JOSEPH RAMAGLIA EIN 13-3562352 EMPLOYEE | Recordkeeping fees; Employee (plan) Service code 30 | — | $116K |
| MELISSA VELAZQUEZ EIN 13-3562352 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $116K |
| VIELKA ARIAS EIN 13-3562352 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| KMR SYSTEMS CORP EIN 13-3192128 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $76K |
| MARSHALL & MOSS,LLP EIN 11-3360166 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $73K |
| ERIKA PEREZ EIN 13-3562352 EMPLOYEE | Employee (plan); Recordkeeping fees Service code 30 | — | $71K |
| MARSHALL & MOSS,PAYROLL COMPLIANCE EIN 04-3652965 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $59K |
| PITTA LLP EIN 26-3852082 NONE | Legal; Direct payment from the plan Service code 29 | — | $55K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $49K |
| EMPIRX HEALTH EIN 47-1226691 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $42K |
| ZAIDA DE LA CRUZ EIN 13-3562352 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $33K |
| NOVAK FRANCELLA, LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $32K |
| WORKFORCE ASSISTANCE PROGRAMS NONE | Other services; Direct payment from the plan Service code 49 | 211 EAST MAIN ST, 161 NEW ROCHELLE, NY 10801 | $32K |
| BARNES, IACCARINO, & SHEPERD LLP EIN 26-3858697 NONE | Legal; Direct payment from the plan Service code 29 | — | $31K |
| ADMINISTRATIVE SERVICES ONLY EIN 11-2995970 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $30K |
| LONG ISLAND SERVER SOLUTIONS NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 1000 FORT SALONGA RD NORTHPORT, NY 11768 | $19K |
| CONTEGIX LLC EIN 23-2826293 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $15K |
| AMERICAN REALTY ADVISORS EIN 33-0123114 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $11K |
| AMALGAMATED BANK OF NY EIN 13-4920330 NONE | Other services; Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $10K |
| IRON MOUNTAIN INC EIN 23-2588479 NONE | Other fees; Direct payment from the plan Service code 50 | — | $9K |
| HELPSYSTEMS EIN 30-0290533 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $7K |
| SEGAL MARCO ADVISORS EIN 13-2646110 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $7K |
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 | 988 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,014 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 742 | $25K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE INC | 2,006 | $1.1M |
| Other | SYMETRA LIFE INSURANCE COMPANY | 742 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,006 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.