| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHALOM STERN3 | 3004 AVE L BROOKLYN, NY 11210 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $19K | — | $19K | 1.57% |
| TOM DUSI3 Filed as: TOM Z DUSI | 101 12 95 STREET OZONE PARK, NY 11416 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $19K | — | $19K | 1.57% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL S | 1133 WESTCHESTER AVE STE S229 WHITE PLAINS, NY 10604 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $9K | — | $9K | 0.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $62K |
| DANIEL H. COOK ASSOCIATES EIN 11-2424843 CONTRACT ADMIN | Contract Administrator; Direct payment from the plan Service code 13 | — | $55K |
| SEGAL COMPANY EIN 13-1835864 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $24K |
| WELBY, BRADY & GREENBLATT, LLP EIN 13-3864481 NONE | Legal; Direct payment from the plan Service code 29 | — | $12K |
| COLLERAN, O'HARA & MILLS EIN 11-2940050 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $11K |
| WELLS FARGO ADVISORS, LLC EIN 34-1542819 NONE | Investment advisory (plan); Custodial (securities); Float revenue Service code 19 | — | $6K |
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 | 187 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 127 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 314 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 88 | $1.2M |
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 180 | $20K |
| Short-term disability | THE UNION LABOR LIFE INSURANCE COMPANY | 180 | $20K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 180 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.