| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSEY INC. | P.O. BOX 416315 BOSTON, MA 02241 | GUARDIAN | $5K | — | $5K | 5.72% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST | 200 LIBERTY STREET NEW YORK, NY 10281 | GUARDIAN | $925 | $725 | $2K | 1.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW JERSERY, INC. | 150 JOHN F KENNEDY PKWY SUITE 52, P.O. BOX 5002 SHORT HILLS, NJ 07078 | UNUM LIFE INSURANCE COMPANY | $4K | $849 | $5K | 7.77% |
| VINCENT D'AMBROSIO3 | 109 RADCLIFF RD STATEN ISLAND, NY 10305 | AFLAC | $686 | — | $686 | 21.29% |
| CORI SHAI HABER3 | 14 WALL ST SUITE 8C NEW YORK, NY 10005 | AFLAC | $610 | — | $610 | 18.93% |
| KEITH LEPACK3 | 1991 BROADWAY APT 12B NEW YORK, NY 10023 | AFLAC | $248 | — | $248 | 7.70% |
| PATRICK RUHLE3 Filed as: PATRICK C HARDIE | 14 WALL ST SUITE 8C NEW YORK, NY 10005 | AFLAC | $170 | — | $170 | 5.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC. EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $56K |
| ASSUREDPARTNERS OF NORTHEAST LLC EIN 45-3443572 BROKER | Other commissions Service code 55 | — | $13K |
| VISION SERVICE PLAN EIN 22-2777159 VISION ADMIN | Claims processing Service code 12 | — | $11K |
| DELTA DENTAL OF NEW YORK EIN 11-1980218 DENTAL ADMIN | Claims processing Service code 12 | — | $10K |
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 | 137 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 7 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GUARDIAN | 137 | $94K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY | 127 | $68K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 137 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
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.