| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MICHAEL C WALKER3 Filed as: MICHAEL JORDAN | — | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $19K | — | $19K | 5.42% |
| LABOR FIRST LLC3 Filed as: LABOR-FIRST LLC | 1000 MIDATLANTIC DRIVE SUITE 100 MOUNT LAUREL, NJ 080541513 | HUMANA INSURANCE COMPANY OF NEW YORK | $350 | — | $350 | 0.23% |
| BODNER BENEFITS GROUP INC3 | 4 CYR CT NEW CITY, NY 10956 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $3K | — | $3K | 7.89% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INS SERVICES INC | 1000 WOODBURY ROAD SUITE 403 WOODBURY, NY 11797 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | — | $2K | $2K | 4.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC EIN 23-7391136 NONE | Claims processing; Direct payment from the plan; Contract Administrator; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $236K |
| R. BASULTO EIN 13-5520944 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $146K |
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $94K |
| P. KIERNAN EIN 13-5520944 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $93K |
| S. D FREDA EIN 13-5520944 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $70K |
| THE SEGAL CO (EASTERN STATES) INC EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $43K |
| ROBERT HALF EIN 94-1648752 NONE | Direct payment from the plan; Other services Service code 49 | — | $34K |
| CYBERSECOP EIN 82-5102442 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $19K |
| DECUSOFT, LLC EIN 84-5099151 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $19K |
| GUARDIAN LIFE INSURANCE EIN 13-5123390 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $18K |
| EXPRESS SCRIPTS, INC EIN 43-1420563 NONE | Contract Administrator; Claims processing; Direct payment from the plan; Other fees Service code 12 | — | $18K |
| COLLERAN, O'HARA & MILLS LLP EIN 11-2940050 LEGAL | Legal; Direct payment from the plan Service code 29 | — | $17K |
| INTERNATIONAL FOUNDATION OF EMPLOYE NONE | Other services; Direct payment from the plan Service code 49 | 18700 W. BLUEMOUND RD. BROOKFIELD, WI 53045 | $12K |
| S. MORGAN EIN 13-5520944 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $8K |
| AMERICAN PORTFOLIOS FINANCIAL SVCS. EIN 11-3018002 INVESTMENT MGMT | Investment management fees paid directly by plan; Investment management Service code 28 | — | $8K |
| LABOR FIRST EIN 06-1750191 NONE | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $8K |
| SEGAL SELECT INSURANCE SVCS, INC. EIN 46-0619194 NONE | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $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 | 266 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 98 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 364 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HUMANA INSURANCE COMPANY OF NEW YORK | 40 | $280K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 350 | $34K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 626 | $356K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 626 | — |
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."
No prospect flags tripped on this filing.