| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SHALOM STERN3 | 3004 AVE L BROOKLYN, NY 11210 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $30K | — | $30K | 1.62% |
| TOM DUSI3 Filed as: TOM Z DUSI | 101 12 95 STREET OZONE PARK, NY 11416 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $30K | — | $30K | 1.62% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL S | 21650 OXNARD STREET STE 200 WOODLAND HILLS, CA 91367 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $27K | $27K | 1.43% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS & FINANCIAL S | 21650 OXNARD STREET STE 200 WOODLAND HILLS, CA 91367 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $0 | $431 | $431 | 4.52% |
| SHALOM STERN3 | 3004 AVE L BROOKLYN, NY 11210 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $356 | — | $356 | 3.73% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $71K |
| DANIEL H. COOK ASSOCIATES EIN 11-2424843 CONTRACT ADMIN | Direct payment from the plan; Contract Administrator Service code 13 | — | $60K |
| SEGAL COMPANY EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $48K |
| COLLERAN, O'HARA & MILLS EIN 11-2940050 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $14K |
| WELLS FARGO ADVISORS, LLC EIN 34-1542819 NONE | Float revenue; Investment advisory (plan); Custodial (securities) 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 | 268 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 121 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 389 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 126 | $1.9M |
| Life insurance(2 contracts, 2 carriers) | THE UNION LABOR LIFE INSURANCE COMPANY | 250 | $35K |
| Short-term disability | THE UNION LABOR LIFE INSURANCE COMPANY | 250 | $25K |
| Other(2 contracts) | THE UNION LABOR LIFE INSURANCE COMPANY | 250 | $36K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.