| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RUGGIERI CONSULTING GROUP LLC3 Filed as: RUGGIERI CONSULTING | 355 LEXINGTON AVENUE 22ND FLOOR NEW YORK, NY 10017 | AETNA LIFE INSURANCE CO. | $10K | $0 | $10K | 3.63% |
| FNA INSURANCE SERVICES INC3 | 1000 WOODBURY ROAD SUITE 403 WOODBURY, NY 11797 | AETNA LIFE INSURANCE CO. | $4K | $0 | $4K | 1.67% |
| FNA INSURANCE SERVICES INC3 | 100 SUNNYSIDE BLVD WOODBURY, NY 11797 | AETNA LIFE INSURANCE CO. | $794 | $0 | $794 | 0.30% |
| RUGGIERI, PHILIP3 Filed as: RUGGIERI PHILIP | 355 LEXINGTON AVE NEW YORK, NY 10017 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $6K | $0 | $6K | 10.88% |
| ROBERT D WOLF3 Filed as: ROBERT D. WOLF III | 511 GRASSMERE AVE INTERLAKEN, NJ 07712 | UNION SECURITY INSURANCE COMPANY | $2K | $0 | $2K | 6.46% |
| ROBERT D WOLF3 | 355 LEXINGTON AVE 22ND FL NEW YORK, NY 10017 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $1K | $0 | $1K | 4.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Contract Administrator; Other services; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing Service code 12 | — | $639K |
| ROBERT D WOLF NONE | Insurance brokerage commissions and fees; Insurance agents and brokers; Other commissions Service code 22 | 355 LEXINGTON AVE 22ND FL NEW YORK, NY 10017 | $233K |
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 | 751 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 763 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 1,041 | $598K |
| Dental | AETNA LIFE INSURANCE CO. | 618 | $266K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 625 | $25K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 715 | $59K |
| Short-term disability | UNION SECURITY INSURANCE COMPANY | 181 | $34K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 1,041 | $598K |
| Other | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 715 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,041 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.