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| Provider | Services | Address | Compensation |
|---|---|---|---|
| ASHLEY TILEBEIN EIN 22-3163161 EMPLOYEE | Direct payment from the plan; Plan Administrator Service code 14 | — | $17K |
| PIERCE PARK GROUP EIN 51-0311895 NONE | Direct payment from the plan; Investment management Service code 28 | — | $14K |
| INSERO & CO. CPAS, LLP EIN 47-5324570 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $12K |
| DAVID KLINE NONE | Legal; Direct payment from the plan Service code 29 | 137 BARTON ROAD PENNELLVILLE, NY 13132 | $10K |
| SONDRA VORHIS EIN 22-3163161 EMPLOYEE | Plan Administrator; Direct payment from the plan Service code 14 | — | $8K |
| O'SULLIVAN ASSOCIATES EIN 20-8199367 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $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 | 86 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 33 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 119 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 93 | $609K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 93 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.