| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL OPPEDISANO3 | PO BOX 183 NORTH STATION WHITE PLAINS, NY 10603 | HIP AN EMBLEM HEALTH COMPANY | $28K | — | $28K | 4.06% |
| MICHAEL OPPEDISANO3 | PO BOX 183 NORTH STATION WHITE PLAINS, NY 10603 | HIP AN EMBLEM HEALTH COMPANY | $24K | — | $24K | 3.85% |
| MICHAEL OPPEDISANO3 | PO BOX 183 NORTH STATION WHITE PLAINS, NY 10603 | EMBLEM HEALTH | $3K | — | $3K | 4.00% |
| MICHAEL OPPEDISANO3 | PO BOX 183 NORTH STATION WHITE PLAINS, NY 10603 | HIP AN EMBLEM HEALTH COMPANY | $945 | — | $945 | 3.84% |
| MICHAEL OPPEDISANO3 | PO BOX 183 NORTH STATION WHITE PLAINS, NY 10603 | HIP AN EMBLEM HEALTH COMPANY | $248 | — | $248 | 3.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ACCLAIM ADMINISTRATORS, LLP EIN 11-3475850 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Participant communication Service code 13 | — | $72K |
| UI & SE UNION LOCAL 122 EIN 11-3303942 AFFILIATED LOCAL | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Plan Administrator Service code 14 | — | $57K |
| S.A. KOENIG & ASSOCIATES, CPAS, P.C EIN 11-3141654 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | 485 UNDERHILL BLVD STE 100 SYOSSET, NY 11791 | $16K |
| INNOVATIVE TAX SOLUTIONS EIN 20-0001649 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $8K |
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 | 139 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | 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."
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.