| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HARBRIDGE CONSULTING GROUP LLC3 | 1 LINCOLN CENTER 12TH FLOOR SYRACUSE, NY 13202 | EXCELLUS BCBS | — | $36K | $36K | 4.31% |
| WINSTON FINANCIAL SERVICES3 Filed as: WINSTON FINANCIAL SERVICES INC | 2399 HWY 34 SOUTH UNIT C2 MANASQUAN, NJ 08736 | FORT DEARBORN LIFE INSURANCE COMPANY | $969 | — | $969 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HOLM & OHARA LLP EIN 13-3591118 NONE | Legal Service code 29 | 3 WEST 35TH STREET 9TH FLOOR NEW YORK, NY 10001 | $14K |
| PATTISON KOSKEY HOWE & BUCCI EIN 14-1746505 NONE | Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 14 | 2880 RT 9 VALATIE, NY 12184 | $14K |
| GOULD KOBRICK & SCHLAPP PC EIN 13-3082707 NONE | Accounting (including auditing) Service code 10 | 3 PARK AVE 14TH FLOOR NEW YORK, NY 10016 | $14K |
| UBS FINANCIAL SERVICES INC. EIN 13-2638166 NONE | Investment advisory (plan) Service code 27 | — | $3K |
| UBS FINANCIAL SERVICES INC. 13-2638 | Other fees Service code 99 | — | $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 | 61 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BCBS | 61 | $841K |
| Life insurance(2 contracts, 2 carriers) | FORT DEARBORN LIFE INSURANCE COMPANY | 66 | $11K |
| Short-term disability | FORT DEARBORN LIFE INSURANCE COMPANY | 66 | $6K |
| Prescription drug | EXCELLUS BCBS | 61 | $841K |
| Other | FORT DEARBORN LIFE INSURANCE COMPANY | 66 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 66 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.