| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY Filed as: SEGAL COMPANY | 333 W 34TH STREET FLOOR 2 NEW YORK, NY 10001 | AETNA LIFE INSURANCE COMPANY | — | $23K | $23K | 2.36% |
| THE SEGAL COMPANY3 Filed as: SEGAL COMPANY EASTERN STATES INC | 30 WATERSIDE DR SUITE 300 FARMINGTON, CT 060323069 | FORT DEARBORN LIFE INSURANCE COMPANY | $12K | $368 | $12K | 5.16% |
| THOMAS M. HANLEY3 | 108 W. JEFFERSON STREET, SUITE 500 SYRACUSE, NY 13202 | FORT DEARBORN LIFE INSURANCE COMPANY | — | $7K | $7K | 3.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| POMCO EIN 15-0581348 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $300K |
| THE SEGAL CO. EIN 13-1835864 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $104K |
| SHEILA J FITZMAURICE EIN 15-6026163 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $91K |
| STACY BRAUN ASSOCIATES EIN 13-2889432 NONE | Direct payment from the plan; Investment management Service code 28 | — | $73K |
| BLITMAN & KING EIN 16-1047304 NONE | Legal; Direct payment from the plan Service code 29 | — | $67K |
| STACY FREITAG EIN 15-6025163 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $65K |
| DARLENE LOSTUMBO EIN 15-6025163 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $45K |
| JOSEPH W. MCCARTHY & ASSOC EIN 16-1120588 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $44K |
| BONADIO & CO., LLP EIN 16-1131146 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $33K |
| EMPLOYEE NETWORK, INC. EIN 16-1285790 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $20K |
| M&T BANK EIN 15-0385555 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $12K |
| MARCO CONSULTING GROUP EIN 36-3555078 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $10K |
| ELIZA POTEKHIN EIN 15-6025163 EMPLOYEE | Direct payment from the plan; Plan Administrator Service code 14 | — | $8K |
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 | 848 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 264 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | FORT DEARBORN LIFE INSURANCE COMPANY | 1,242 | $234K |
| Short-term disability | FORT DEARBORN LIFE INSURANCE COMPANY | 1,242 | $234K |
| Stop-loss / reinsurancereinsurance | AMERICAN ALTERNATIVE INSURANCE CORPORATION | 811 | $303K |
| Other | FORT DEARBORN LIFE INSURANCE COMPANY | 1,242 | $234K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,242 | — |
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.