| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MSM GENERAL AGENCY INC Filed as: MSM GENERAL AGENCY INC. | 2300 HYLAN BOULEVARD, SUITE 2 STATEN ISLAND, NY 10306 | ZURICH AMERICAN INSURANCE COMPANY | $2K | — | $2K | 10.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ZENITH AMERICAN SOLUTIONS EIN 52-1590516 SERV FOR RELATED BEN PL | Claims processing; Contract Administrator Service code 12 | — | $662K |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Float revenue; Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $441K |
| THE SEGAL COMPANY(EASTERN STATES) I EIN 13-1835864 SERV FOR RELATED BEN PL | Consulting (general) Service code 16 | — | $61K |
| CLEARY, JOSEM & TRIGIANI, LLP EIN 23-2657967 SERV FOR UNION & BENE PL | Legal Service code 29 | — | $57K |
| MED REVIEW, INC. EIN 13-3240352 NONE | Claims processing Service code 12 | — | $51K |
| KLEIN ZELMAN ROTHERMEL JACOBS SCHES EIN 13-2998136 SERV FOR RELATED BEN PL | Legal Service code 29 | — | $44K |
| BUCHBINDER TUNICK & CO. LLP EIN 13-1578842 SERV FOR RELATED BENE PL | Accounting (including auditing) Service code 10 | — | $39K |
| LABOR EDUC & COMMUNITY SERV AGENCY EIN 23-7442181 NONE | Other services Service code 49 | — | $34K |
| ROGER MAHER, ESQ. SERV FOR RELATED BEN PL | Other services Service code 49 | 23 83RD STREET BROOKLYN, NY 11209 | $8K |
| AMALGAMATED BANK OF CHICAGO EIN 36-0721895 SERV FOR RELATED BEN PL | Custodial (securities) Service code 19 | — | $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 | 1,398 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,402 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,483 | $129K |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK | 1,394 | $894K |
| Other(2 contracts, 2 carriers) | EMBLEM HEALTH (HIP HEALTH PLAN OF NY) | 1,398 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,483 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.