No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NEW YORK HEALTHY REPUBLIC EIN 99-9999999 | Insurance services Service code 23 | 30 BROAD STREET NEW YORK, NY 10004 | $1.4M |
| OXFORD HEALTH PLAN EIN 06-1181200 | Insurance services Service code 23 | PO BOX 1697 NEWARK, NJ 07101 | $786K |
| SERVICE STATION DEALER OF GREATER N EIN 23-7085678 | Accounting (including auditing) Service code 10 | 4210WAVERLY AVENUE MAMARONECK, NY 10543 | $58K |
| GUARDIAN EIN 13-5123390 | Insurance services Service code 23 | PO BOX 824404 PHILADELPHIA, PA 19182 | $49K |
| SHELTER POINT LIFE EIN 11-2284118 | Insurance services Service code 23 | PO BOX 220727 GREAT NECK, NY 11021 | $15K |
| EMPIRE BLUE CROSS EIN 23-7391136 | Insurance services Service code 23 | PO BOX 1407 CHURCH STRET STATION, NY 10008 | $14K |
| LILLING & COMPANY EIN 13-3447681 | Accounting (including auditing) Service code 10 | — | $12K |
| THE HARTFORD EIN 06-0974148 | Insurance services Service code 23 | PO BOX 783690 PHILADELPHIA, PA 19178 | $11K |
| LEOTTA & ASSOCIATES CPA PLLC EIN 20-8087020 | Accounting (including auditing) Service code 10 | 172 MAIN ST NANUET, NY 10954 | $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 | 168 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 168 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 6 carriers) | OXFORD INSURANCE CO. | 54 | $0 |
| Dental | GUARDIAN DENTAL | 47 | $0 |
| Life insurance | 0 | $0 | |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 54 | — |
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.