| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FNA INSURANCE SERVICES INC3 Filed as: FNA INSURANCE SERVICES, INC | 1000 WOODBURY ROAD STE 403 WOODBURY, NY 11797 | HARTFORD LIFE AND ACCIDENT | $5K | $5K | $10K | 15.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE BLUE CROSS BLUE SHIELD EIN 23-7391136 NONE | Claims processing; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $198K |
| L. FUSCO EIN 13-5520944 NONE | Employee (plan) Service code 30 | — | $142K |
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 AUDITOR | Accounting (including auditing) Service code 10 | — | $92K |
| COLLERAN, O'HARA & MILLS LLP EIN 11-2940050 LEGAL | Legal Service code 29 | — | $85K |
| R. BASULTO EIN 13-5520944 NONE | Employee (plan) Service code 30 | — | $81K |
| P. KIERNAN EIN 13-5520944 NONE | Employee (plan) Service code 30 | — | $80K |
| S. D FREDA EIN 13-5520944 NONE | Employee (plan) Service code 30 | — | $68K |
| FIRST ACTUARIAL CONSULTING, INC. EIN 26-3842522 NONE | Actuarial Service code 11 | — | $29K |
| GUARDIAN LIFE INSURANCE EIN 13-5123390 NONE | Claims processing Service code 12 | — | $21K |
| CLEARARC CAPITAL, INC. EIN 31-1051736 NONE | Investment management; Soft dollars commissions; Investment management fees paid indirectly by plan; Investment management fees paid directly by plan Service code 28 | — | $19K |
| DTM CONSULTING EIN 04-3607413 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $18K |
| DECUSOFT, LLC EIN 02-0643827 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $12K |
| C&R CONSULTING, INC. EIN 13-3935364 NONE | Claims processing Service code 12 | — | $11K |
| AMALGAMATED BANK OF NY EIN 13-4920330 NONE | Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $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 | 330 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 107 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 437 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 425 | $62K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE, INC. (G1921) | 882 | $391K |
| Other | HARTFORD LIFE AND ACCIDENT | 425 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 882 | — |
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.