| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT BERGMAN | 123 KILBURN DRIVE CHERRY HILL, NJ 08003 | AMALGAMATED LIFE | $1K | — | $1K | 5.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUESHIELD OF NORTHEASTERN NEW YORK EIN 16-1105741 THIRD PARTY | Claims processing Service code 12 | 30 CENTURY HILL DRIVE LATHAM, NY 12110 | $127K |
| UNITED ACTUARIAL SERVICES EIN 35-2156428 THIRD PARTY | Actuarial Service code 11 | 11590 N. MERIDIAN ST. CARMEL, IN 46032 | $40K |
| BLITMAN & KING, LLP EIN 16-1047304 THIRD PARTY | Legal Service code 29 | 443 N. FRANKLIN ST. SUITE 300 SYRACUSE, NY 13204 | $40K |
| BONNIE ALLMAN EIN 14-1512731 EMPLOYEE | Employee (plan) Service code 30 | 890 THIRD ST. ALBANY, NY 12206 | $37K |
| BERNICE MCCULLOUGH EIN 14-1512731 EMPLOYEE | Employee (plan) Service code 30 | 890 THIRD ST. ALBANY, NY 12206 | $26K |
| MANNING & NAPIER ADVISORS, INC. EIN 45-3328488 THIRD PARTY | Investment advisory (plan) Service code 27 | 290 WOODCLIFF DRIVE FAIRPORT, NY 14450 | $22K |
| DARCANGELO & CO. LLP EIN 13-2250103 THIRD PARTY | Accounting (including auditing) Service code 10 | 120 LOMOND COURT UTICA, NY 13502 | $11K |
| DELTA DENTAL EIN 11-1980218 THIRD PARTY | Claims processing Service code 12 | ONE DELTA DRIVE MECHANICSBURG, PA 17055 | $6K |
| WELLS FARGO EIN 41-6257133 THIRD PARTY | Custodial (securities) Service code 19 | 160 LINDEN OAKS DRIVE ROCHESTER, NY 14625 | $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 | 256 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE | 277 | $24K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 258 | $97K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.