| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | 99 TROY ROAD EAST GREENBUSH, NY 12061 | DELTA DENTAL OF NEW YORK | $5K | — | $5K | 8.69% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | 99 TROY ROAD EAST GREENBUSH, NY 12061 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $4K | $436 | $4K | 10.08% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | 99 TROY ROAD EAST GREENBUSH, NY 12061 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 10.00% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | 99 TROY ROAD EAST GREENBUSH, NY 12061 | EMPIRE HEALTHCHOICE ASSURANCE, INC | $288 | $83 | $371 | 4.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFIT ADMINISTRATIVE SYSTEMS, LLC EIN 36-4197088 TPA | Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | 17475 JOVANNA DRIVE HOMEWOOD, IL 60430 | $38K |
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW YORK | 179 | $62K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC | 145 | $8K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 120 | $43K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE CO. | 75 | $330K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 120 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.