| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EVOLUTION HEALTHCARE Filed as: EVOLUTION HEALTHCARE LLC | 145 WEST OSTEND ST BALTIMORE, MD 21230 | UNITEDHEALTHCARE INS CO | — | $45K | $45K | 4.00% |
| ANDREW LAVENZIANO | 159 SUMMIT CIR LITTLE FERRY, NJ 07643 | SUN LIFE AND HEALTH INS CO | $3K | — | $3K | 9.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CORESOURCE INC EIN 35-1846036 NONE | Claims processing; Plan Administrator; Other services Service code 12 | — | $565K |
| EMPIRE HEALTHCHOICE INSURANCE EIN 23-7391136 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing; Float revenue Service code 12 | — | $439K |
| ROSA'S INDEMNITY SERVICES, LLC EIN 82-2485404 NONE | Consulting (general); Insurance agents and brokers Service code 16 | — | $335K |
| LAURIE GRECO EIN 20-3244794 EMPLOYEE | Contract Administrator Service code 13 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $93K |
| JACQUELINE ELSNER EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $60K |
| CLAUDIA MARQUEZ EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $56K |
| BRYAN MCCARTHY, ESQ EIN 06-2408495 LAWYER | Insurance agents and brokers Service code 22 | 1454 ROUTE 22 SUITE B101 BREWSTER, NY 10509 | $48K |
| JACKI MITCHELL EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $43K |
| MARCIA SALOMON EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $37K |
| COSTAROTHBORT LLC EIN 46-5286678 ACCOUNTANT | Accounting (including auditing) Service code 10 | 445 BROADHO OW ROAD WMELVILLE, NY 11747 | $26K |
| LINDA MAUGERI EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $25K |
| CATHY VASILE EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $21K |
| ANGELA MCCABE EIN 20-3244794 EMPLOYEE | Trustee (discretionary) Service code 24 | 1065 OLD COUNTRY RD WESTBURY, NY 11590 | $16K |
| SUMMIT ACTUARIAL SERVICES EIN 11-4385930 ACTUARY | Actuarial Service code 11 | 123 PREAKNESS DR. MT. LAUREL, NJ 08054 | $15K |
| ANDREW FAIR, ESQ. EIN 20-3322400 TRUSTEE | Trustee (individual) Service code 20 | 16 INTERLAKEN DR EASTCHESTER, NY 10709 | $12K |
| LOU GACCIONE EIN 05-7646731 TRUSTEE | Trustee (individual) Service code 20 | 906 ATLANTIC AVE BALDWIN, NY 11510 | $12K |
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 | 885 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 888 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.