| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 Filed as: SEGAL COMPANY (EASTERN STATES) INC. | 333 WEST 34TH STREET NEW YORK, NY 10001 | HCC LIFE INSURANCE COMPANY | $10K | — | $10K | 7.00% |
| WALSH JONES AGENCY INC3 Filed as: WALSH JONES AGENCY INC. | 3638 SENECA ST. WEST SENECA, NY 14224 | HARTFORD LIFE INSURANCE CO. | $3K | — | $3K | 14.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 NONE | Claims processing Service code 12 | — | $240K |
| SEGAL COMPANY EIN 13-1835864 NONE | Actuarial; Consulting (general) Service code 11 | — | $116K |
| BLITMAN AND KING, LLP EIN 16-1047304 NONE | Legal Service code 29 | — | $109K |
| SUZANNE RANELLI EIN 16-0776208 EMPLOYEE | Employee (plan) Service code 30 | — | $92K |
| INNOVATIVE SOFTWARE SOLUTIONS, INC. EIN 23-2182079 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $81K |
| LAURIE GOOD EIN 16-0776208 EMPLOYEE | Employee (plan) Service code 30 | — | $60K |
| MELISSA CRAWFORD EIN 16-0776208 EMPLOYEE | Employee (plan) Service code 30 | — | $53K |
| TINA SCHAFFER EIN 16-0776208 EMPLOYEE | Employee (plan) Service code 30 | — | $52K |
| MARIA HILBERT EIN 16-0776208 EMPLOYEE | Employee (plan) Service code 30 | — | $52K |
| ARCARA ZUCARELLI LENDA & ASSOC. CPA EIN 47-1793720 NONE | Accounting (including auditing) Service code 10 | — | $50K |
| LIALETTE BULLOCK EIN 16-0776208 EMPLOYEE | Employee (plan) Service code 30 | — | $48K |
| MANNING & NAPIER, INC. EIN 45-3328488 NONE | Investment management Service code 28 | — | $16K |
| SYSTMS OF NY, INC. EIN 20-3831658 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $13K |
| FAIR HEALTH INC. NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 530 5TH AVENUE NEW YORK, NY 10036 | $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 | 295 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 297 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE CO. | 295 | $33K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 307 | $145K |
| Other | HARTFORD LIFE INSURANCE CO. | 215 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 307 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.