| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DELTA DENTAL OF NEW YORK0 | 1 DELTA DRIVE MECHANICSBURG, PA 17055 | DELTA DENTAL OF NEW YORK | — | $56K | $56K | 6.30% |
| NEW YORK STATE UNITED TEACHERS8 | 800 TROY-SCHENECTADY ROAD LATHAM, NY 121102424 | FIRST UNUM LIFE INSURANCE COMPANY | — | $14K | $14K | 5.00% |
| THE SEGAL COMPANY0 Filed as: PROFESSIONAL GROUP PLANS INC SEGAL | 225 WIRELESS BLVD 2ND FLOOR HAUPPAUGE, NY 11788 | SHELTERPOINT LIFE INSURANCE COMPANY | — | $10K | $10K | 6.27% |
| DAVIS VISION0 | 711 TROY SCHENECTADY RD # 301 LATHAM, NY 121102424 | DAVIS VISION | — | $7K | $7K | 4.43% |
| NEW YORK STATE UNITED TEACHERS8 | 800 TROY SCHENECTADY ROAD LATHAM, NY 121102424 | FIRST UNUM LIFE INSURANCE COMPANY | — | $5K | $5K | 5.00% |
| NEW YORK STATE UNITED TEACHERS4 | 800 TROY SCHENECTADY ROAD LATHAM, NY 121102424 | FIRST UNUM LIFE INSURANCE COMPANY | — | $551 | $551 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC EIN 23-7391136 NONE | Contract Administrator; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue Service code 12 | 1351 WM. HOWARD TAFT RD. CINCINNATI, OH 452061721 | $650K |
| THE SEGAL CO EASTERN STATES INC EIN 13-1835864 | Non-monetary compensation; Other commissions; Insurance agents and brokers Service code 22 | 2727 PACES FERRY ROAD, SUITE 1400 ATLANTA, GA 30339 | $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 | 390 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 505 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 899 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC | 1,576 | $11.5M |
| Dental | DELTA DENTAL OF NEW YORK | 1,851 | $890K |
| Vision | DAVIS VISION | 3,654 | $159K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 385 | $286K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 385 | $109K |
| Prescription drug | CVS PHARMACY, INC | 1,664 | $8.0M |
| Stop-loss / reinsurancereinsurance | SUN LIFE AND HEALTH INSURANCE COMPANY (U.S.) | 887 | $1.2M |
| Other(3 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 403 | $453K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,654 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.