| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BPAS ACTUARIAL AND PENSION SERVICES3 | ONE LINCOLN CENTER SYRACUSE, NY 13202 | EMPIRE HEALTHCHOICE ASSURANCE, INC. (G1921) | $21K | — | $21K | 4.24% |
| WINSTON FINANCIAL SERVICES3 Filed as: WINSTON FINANCIAL SERVICES INC | 2399 HWY 34 SOUTH UNIT C2 MANASQUAN, NJ 08736 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $664 | $664 | 15.00% |
| WINSTON FINANCIAL SERVICES3 Filed as: WINSTON FINANCIAL SERVICES INC | 2399 HWY 34 SOUTH UNIT C2 MANASQUAN, NJ 08736 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | — | $466 | $466 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PATTISON KOSKEY HOWE & BUCCI EIN 14-1746505 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator Service code 14 | 2880 RT 9 VALATIE, NY 12184 | $17K |
| HOLM & OHARA LLP EIN 13-3591118 NONE | Legal Service code 29 | 3 WEST 35TH STREET 9TH FLOOR NEW YORK, NY 10001 | $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 | — | $4K |
| 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 | 36 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 36 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. (G1921) | 35 | $502K |
| Life insurance(2 contracts) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 45 | $8K |
| Short-term disability(2 contracts) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 45 | $8K |
| Other(2 contracts) | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 45 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 45 | — |
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.