| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DELTA DENTAL OF NEW YORK | 11 PENNSYLVANIA PLAZA NEW YORK, NY 10001 | DELTA DENTAL OF NEW YORK | $4K | $25K | $29K | 7.75% |
| CAPITAL DISTRICT PHYSICIANS HEALTH | 500 PATROON CREEK BLVD ALBANY, NY 12206 | DELTA DENTAL OF NEW YORK | $2K | — | $2K | 0.50% |
| DELAWARE VALLEY HEALTH CARE | 2980 SOUTHAMPTON RD PHILADELPHIA, PA 19154 | DELTA DENTAL OF NEW YORK | $2K | — | $2K | 0.50% |
| HUB INTERNATIONAL MIDWEST LIMITED Filed as: BOLTON PARTNERS | 900 MID ATLANTIC DRIVE MT. LAUREL, NJ 08054 | UNITED LABOR LIFE INSURANCE COMPANY | $4K | — | $4K | 3.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL DISTRICT PHYSICIANS HEALTH EIN 14-1745298 NONE | Claims processing Service code 12 | 500 PATROON CREEK BLVD ALBANY, NY 12206 | $440K |
| SILVERCREST ASSET MANAGEMENT GROUP EIN 13-4194623 NONE | Investment management Service code 28 | 1330 AVENUE OF THE AMERICAS, 38TH F NEW YORK, NY 10019 | $79K |
| RYAN HEIMROTH EIN 14-6029930 EMPLOYEE | Employee (plan) Service code 30 | 18 AVIS DRIVE LATHAM, NY 12110 | $69K |
| NEW CENTURY ADVISORS EIN 27-0004136 NONE | Investment management Service code 28 | 2 WISCONSIN CIRCLE CHEVY CHASE, MD 20815 | $55K |
| BOLTON PARTNERS NORTHEAST, INC. EIN 27-3666661 NONE | Actuarial; Consulting (general) Service code 11 | 9000 MIDLANTIC DRIVE SUITE 100 MT LAUREL, NJ 08054 | $48K |
| LESLIE A. VANDENBURGH-BALDWIN EIN 14-6029930 EMPLOYEE | Employee (plan) Service code 30 | 18 AVIS DRIVE LATHAM, NY 12110 | $42K |
| TRACEY REX EIN 14-6029930 EMPLOYEE | Employee (plan) Service code 30 | 18 AVIS DRIVE LATHAM, NY 12110 | $42K |
| BLITMAN & KING EIN 16-1047304 NONE | Legal Service code 29 | 800 TROY SCHENECTADY RD LATHAM, NY 12110 | $38K |
| INCOME RESEARCH + MANAGEMENT EIN 04-2955404 NONE | Investment management Service code 28 | 100 FEDERAL STREET BOSTON, MA 02110 | $34K |
| MENGEL, METZGER, BARR, AND CO., EIN 16-1092347 NONE | Accounting (including auditing) Service code 10 | 11 BRITISH AMERICAN BLVD LATHAM, NY 12110 | $30K |
| ISSI EIN 23-2182079 NONE | Other services Service code 49 | TWO EXECUTIVE CAMPUS SUITE 400 CHERRY HILL, NJ 08002 | $29K |
| DELTA DENTAL SERVICES EIN 11-1980218 NONE | Contract Administrator Service code 13 | ONE DELTA DRIVE MECHANICSBURG, PA 17055 | $26K |
| OPTUMRX EIN 33-0441200 NONE | Direct payment from the plan; Other fees; Claims processing; Float revenue Service code 12 | PO BOX 9472 MINNEAPOLIS, MN 554409472 | $24K |
| MPC CAPITAL ADVISORS LLC EIN 27-2136582 NONE | Investment advisory (plan) Service code 27 | 622 THIRD AVE 38TH FLOOR NEW YORK, NY 10017 | $16K |
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 | 787 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 357 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 461 | $628K |
| Dental | DELTA DENTAL OF NEW YORK | 1,015 | $374K |
| Stop-loss / reinsurancereinsurance | UNITED LABOR LIFE INSURANCE COMPANY | 812 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,015 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.