| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NYS UNITED TEACHERS BENEFIT TRUST4 | 800 TROY SCHENECTADY ROAD LATHAM, NY 121102424 | FIRST UNUM LIFE INSURANCE COMPANY | — | $3K | $3K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DEBORAH RUBIN EIN 13-5582895 NONE | Plan Administrator Service code 14 | — | $132K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 NONE | Claims processing Service code 12 | — | $116K |
| THE SEGAL COMPANY EIN 13-1835864 PERF SERV FOR REL UNION | Consulting (general) Service code 16 | — | $106K |
| OTTO BILLER JR. EIN 13-5582895 NONE | Employee (plan) Service code 30 | — | $75K |
| AMALGAMATED BANK EIN 13-4920330 PERF SERV FOR REL UNION | Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $54K |
| BUCHBINDER TUNICK & COMPANY LLP EIN 13-1578842 PERF SERV FOR REL UNION | Accounting (including auditing) Service code 10 | — | $23K |
| MIRKIN & GORDON, P.C EIN 11-2609088 NONE | Legal Service code 29 | — | $16K |
| SEGAL SELECT INSURANCE SERVICES INC | Insurance brokerage commissions and fees Service code 53 | — | $3K |
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 | 1,564 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,584 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 3,586 | $523K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 3,586 | $523K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 1,539 | $67K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 1,539 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,586 | — |
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.