| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GFI INSURANCE BROKERAGE Filed as: GFI INSURANCE BROKERAGE, INC. | 140 BROADWAY, 41ST FLOOR NEW YORK, NY 10005 | EMPIRE HEALTHCHOICE HMO, INC. | $13K | — | $13K | 1.94% |
| CENTERSTONE INSURANCE AND FINANCIAL | 1133 WESTCHESTER AVE STE S229 WHITE PLAINS, NY 10604 | EMPIRE HEALTHCHOICE HMO, INC. | $5K | — | $5K | 0.72% |
| SINGER NELSON CHARLMERS Filed as: SINGER NELSON CHARLMERS INC | TEANECK RD, TEANECK, NJ 07666 | EMPIRE HEALTHCHOICE HMO, INC. | $3K | — | $3K | 0.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ISABEL VAZQUEZ EIN 13-4191811 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $94K |
| GLORIA LARRONDO EIN 13-4191811 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $67K |
| JOSE VEGA EIN 13-4191811 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $51K |
| MARIA LIBRETTI EIN 13-4191811 EMPLOYEE | Direct payment from the plan Service code 50 | — | $44K |
| KEY BENEFIT ADMINISTRATORS, INC. EIN 35-1450364 ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $32K |
| ARMAO LLP EIN 46-2754053 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $14K |
| AMERICAN HEALTH DATA INSTITUTE EIN 35-2048379 ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $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 | 190 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE HMO, INC. | 75 | $654K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 71 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 75 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.