| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENROLLEASE3 Filed as: CLARKE & SAMPSON, INC. | 228 S WASHINGTON ST. SUITE 200 ALEXANDRIA, VA 22314 | THE UNION LABOR LIFE INSURANCE COMPANY | $44K | — | $44K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $2.5M |
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $353K |
| CATHERINE CHASE EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $314K |
| YASIR ELTAYEB EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $232K |
| WILLIAM STANTON EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $223K |
| BRADY MCGUIRE & STEINBERG, PC EIN 13-4089943 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $207K |
| LAURA ADDUCHIO EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $169K |
| RICHARD LOPEZ EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $159K |
| KATHERINE CLANCY EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $142K |
| TELEMEDICINE MANANGEMENT, INC. EIN 26-1306606 NONE | Other services; Direct payment from the plan Service code 49 | — | $139K |
| RICHARD VENEZIA EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $120K |
| MOHAMED KARAMALI EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $120K |
| SAGE ADVISORY SERVICES, LTD. CO. EIN 74-2798841 INVEST MGR | Investment management; Investment management fees paid directly by plan Service code 28 | — | $107K |
| FLORENCE CHASE EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $81K |
| ANGEL MALDONADO EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $73K |
| BASIL CASTROVINCI ASSOC., INC. EIN 13-2831500 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $68K |
| VANESSA ITURRALDE EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $68K |
| OMILLA SINGH EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $63K |
| MARY VENEZIA EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $60K |
| MICHELLE PAONE EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $57K |
| DERRICK OWENS EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $55K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Custodial (securities); Investment management; Investment management fees paid indirectly by plan; Investment management fees paid directly by plan Service code 19 | — | $55K |
| JENNIFER MARINO EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $53K |
| EFRAIN A SEGOVIA EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $52K |
| LETICIA GONZALES EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $51K |
| NICOLE PAONE EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $48K |
| DENISSE ITURRALDE EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $42K |
| SEGAL CONSULTING EIN 13-1835864 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $38K |
| GRM DOCUMENT MANAGEMENT EIN 13-3468713 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $35K |
| EVEREADY GRAPHICS EIN 46-3471000 NONE | Direct payment from the plan; Other services Service code 49 | — | $35K |
| KAREN CONWAY EIN 13-6694320 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $34K |
| VIRGINIA HARTMANN EIN 13-6694320 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $32K |
| OPTUMRX, INC. EIN 33-0441200 NONE | Float revenue; Other fees; Direct payment from the plan; Claims processing Service code 12 | — | $29K |
| SAFEGUARD BUSINESS SYSTEMS EIN 23-1689322 NONE | Other services; Direct payment from the plan Service code 49 | — | $16K |
| CLARKE & SAMPSON, IN. | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $7K |
| MOSAIC DATA SERVICES INC. EIN 27-4716698 NONE | Direct payment from the plan; Other services Service code 49 | — | $5K |
| CLARKE & SAMPSON, INC | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $2K |
| CLARKE & SAMPSON, INC. EIN 54-0657005 INSURANCE BROKER | Insurance brokerage commissions and fees Service code 53 | — | $0 |
| OPTUMRX, INC | Other fees Service code 99 | — | $0 |
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 | 3,210 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 3,210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Short-term disability | THE UNION LABOR LIFE INSURANCE COMPANY | 2,449 | $880K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 540 | $473K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 2,449 | $880K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,449 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.