| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 | 333 W. 34 ST. NEW YORK, NY 10001 | RELIASTAR LIFE INSURANCE COMPANY | $42K | — | $42K | 3.50% |
| THE SEGAL COMPANY3 Filed as: SEGAL CO EASTERN STATES INC | 333 W. 34 ST. NEW YORK, NY 10001 | MEDICAL EXCESS | $36K | — | $36K | 5.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 06-0303370 NONE | Non-monetary compensation; Float revenue; Participant communication; Direct payment from the plan; Named fiduciary; Claims processing; Contract Administrator; Other services Service code 12 | — | $814K |
| STEPTOE & JOHNSON EIN 52-1349790 NONE | Non-monetary compensation; Legal; Direct payment from the plan Service code 29 | — | $277K |
| IOMM&P EIN 13-6020335 SPONSORING UNION | Plan Administrator; Direct payment from the plan Service code 14 | — | $274K |
| MULTIPLAN EIN 06-1533300 NONE | Claims processing; Other services; Direct payment from the plan Service code 12 | — | $213K |
| DELTA DENTAL EIN 23-1667011 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $206K |
| PATRICK MCCULLOUGH EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $173K |
| KEN RYAN EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $130K |
| ANN MARIE MCCULLOUGH EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $123K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Consulting (general); Direct payment from the plan; Actuarial; Insurance agents and brokers Service code 11 | — | $114K |
| PAULA PHILLIPS EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $111K |
| INVESCO EIN 58-1709953 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $89K |
| STACEY SULLIVAN EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $87K |
| DALE CLARK EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $86K |
| MADELINE PETRELLI EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $79K |
| DAVID ROMANO EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $79K |
| JOSEPH GIUSTO EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $65K |
| KATHLEEN BROWN EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $61K |
| KIMBERLY GABLE EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $61K |
| MICHAEL MCCULLOUGH EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $60K |
| MARY RIDGELY EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $59K |
| GORFINE SCHILLER & GARDYN PA EIN 52-1231901 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $58K |
| KOPELMAN & PAIGE, P.C. EIN 04-2746356 NONE | Legal; Direct payment from the plan Service code 29 | — | $58K |
| MARCIA FAWTHROP EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $57K |
| DEBRA CAVEY EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $54K |
| ALICE ANDRZEJEWSKI EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $47K |
| RUSS BALZARINI EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $42K |
| DIANE FITZBERGER EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $41K |
| JAMES MURPHY EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $40K |
| ELIZABETH HOLLYWOOD EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $40K |
| KATHY WRIGHT EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $40K |
| HOWARD ROBERTS EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $39K |
| JESSICA WELSH EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $39K |
| MARY JURNEY EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $39K |
| KATHLEEN CLEVENGER EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $38K |
| AMY FOSSETT EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $37K |
| DENISE BRINKMAN EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $37K |
| CHARLENE ROGERS EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $35K |
| SLEVIN & HART EIN 52-1708613 NONE | Non-monetary compensation; Legal; Direct payment from the plan Service code 29 | — | $35K |
| JENNIFER KELLNER EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $34K |
| VERA BRENNAN EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $33K |
| JEAN ADAMS-MENICK EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $32K |
| MASHA JURNEY EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $29K |
| LYNN CONWAY EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $27K |
| LISA LINDAUER EIN 13-6696938 EMPLOYEE | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $25K |
| CLAIRE FORD EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $23K |
| FAIR HEALTH EIN 90-0524293 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $23K |
| DORIS MILLER EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $21K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $18K |
| LIFEWORKS US INC EIN 81-1114266 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $18K |
| JOYCE BOSSOM EIN 13-6696938 EMPLOYEE | Direct payment from the plan; Employee (plan sponsor) Service code 35 | — | $17K |
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 | 2,862 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,710 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,572 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 776 | $1.8M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL | 108 | $192K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 776 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.