| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTER CITY AGENCY, INC.3 | 4240 BELL BOULEVARD, SUITE 103 BAYSIDE, NY 11361 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $97K | — | $97K | 3.93% |
| DONALD C SAVOY INC3 Filed as: DONALD C. SAVOY, INC. | 25B HANOVER ROAD, SUITE 220 FLORHAM PARK, NJ 07932 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $27K | — | $27K | 1.11% |
| INTER CITY AGENCY, INC.3 | 4240 BELL BOULEVARD, SUITE 103 BAYSIDE, NY 11361 | DELTA DENTAL OF NEW YORK | $8K | — | $8K | 5.00% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS | UNKNOWN LAKE SUCCESS, NY 11042 | DELTA DENTAL OF NEW YORK | $3K | — | $3K | 2.00% |
| INTER CITY AGENCY, INC.3 | 4240 BELL BOULEVARD, SUITE 103 BAYSIDE, NY 11361 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $1K | — | $1K | 12.88% |
| SAVOY ASSOCIATES3 | 258B HANOVER ROAD FLORHAM PARK, NJ 07932 | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | $434 | — | $434 | 5.00% |
No Schedule C service providers reported on this filing.
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 | 167 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 167 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 267 | $2.5M |
| Dental | DELTA DENTAL OF NEW YORK | 454 | $162K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 267 | $2.5M |
| Life insurance | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 167 | $9K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 267 | $2.5M |
| Other | ANTHEM LIFE AND DISABILITY INSURANCE COMPANY | 167 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 454 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.