No insurance carriers on this filing. Self-funded welfare plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CROSSROADS HEALTHCARE MANAGEMENT LL EIN 74-3064316 NONE | Accounting (including auditing); Contract Administrator Service code 10 | 2556 ARTHUR KILL ROAD STATEN ISLAND, NY 10309 | $2.6M |
| OFFICE OF POOL ADMIN CENTRAL NY REG EIN 15-0329043 NONE | Other services Service code 49 | P.O. BOX 4757 SYRACUSE, NY 132214757 | $1.6M |
| LAW OFFICES OF THOMAS A. THOMPSON NONE | Legal Service code 29 | 148 WHITES COVE ROAD, SUITE 1 YARMOUTH, ME 04096 | $442K |
| PROSCRIPT PHARMACY MANAGEMENT LLC EIN 20-1381813 NONE | Other services Service code 49 | 2556 ARTHUR KILL ROAD STATEN ISLAND, NY 10309 | $362K |
| MAGNACARE EIN 11-3410766 NONE | Other services Service code 49 | 825 EAST GATE BLVD GARDEN CITY, NY 11530 | $233K |
| QUALCARE EIN 22-3129563 NONE | Other services Service code 49 | P.O. BOX 48089 NEWARK, NJ 07101 | $180K |
| DAVIS VISION INC EIN 11-2358021 NONE | Other services Service code 49 | 175 EXPRESS ST., P.O. BOX 9122 PLAINVIEW, NY 11803 | $123K |
| SAMUEL GOLDSTEIN & CO., P.C. EIN 11-2478817 NONE | Accounting (including auditing) Service code 10 | 150 GREAT NECK ROAD - SUITE 202 GREAT NECK, NY 11021 | $73K |
| ROLAND R. ACEVEDO EIN 13-3056117 NONE | Legal Service code 29 | 444 MADISON AVENUE - 30TH FLOOR NEW YORK, NY 100226926 | $61K |
| DDS SERVICES INC EIN 11-2705347 NONE | Other services Service code 49 | 1640 HEMPSTEAD TURNPIKE EAST MEADOW, NY 11554 | $48K |
| SAVASTA AND COMPANY INC EIN 13-3879959 NONE | Actuarial Service code 11 | SIXTY BROAD STREET - 37TH FLOOR NEW YORK, NY 10004 | $48K |
| VISION SCREENING INC EIN 11-2358021 NONE | Other services Service code 49 | 1919 MIDDLE COUNTRY ROAD SUITE 304 CENTEREACH, NY 11720 | $31K |
| PERFECT PRINTING SOLUTIONS INC EIN 46-1378840 NONE | Copying and duplicating Service code 36 | 34 EAST MAIN STREET 396 SMITHTOWN, NY 117872841 | $30K |
| GENERAL VISION SERVICES LLC EIN 11-3580756 NONE | Other services Service code 49 | P.O. BOX 8000, DEPT 79 BUFFALO, NY 14267 | $25K |
| DAVID R PFAFF, MD EIN 13-3687263 NONE | Consulting fees Service code 70 | 3311 HYLAN BLVD STATEN ISLAND, NY 10306 | $24K |
| BROADVIEW ADVISORS LLC EIN 39-2020480 NONE | Investment management fees paid directly by plan Service code 51 | 333 EAST KILBOURN AVE., SUITE 1475 MILWAUKEE, WI 53202 | $23K |
| PALMER-TANNO AGENCY INC EIN 13-1977110 NONE | Insurance agents and brokers Service code 22 | 33 WEST MAIN STREET SUITE 408 ELMSFORD, NY 10523 | $16K |
| UNITED HEALTHCARE INSURANCE CO EIN 36-2739571 NONE | Other services Service code 49 | P.O. BOX 5840 CAROL STREAM, IL 601975840 | $15K |
| STACEY BRAUN ASSOCIATES EIN 13-2889432 NONE | Investment management fees paid directly by plan Service code 51 | 377 BROADWAY NEW YORK, NY 10013 | $10K |
| INVESTMENT CONSULTING SERVICES LLC EIN 32-0016703 NONE | Consulting fees Service code 70 | 2215 YORK ROAD - SUITE 206 OAK BROOK, IL 60523 | $8K |
| C. S. MCKEE, L.P. EIN 25-1900687 NONE | Investment management fees paid directly by plan Service code 51 | ONE GATEWAY CENTER, 8TH FLOOR PITTSBURGH, PA 15239 | $6K |
| UNION MUTUAL MEDICAL FUND EIN 22-2241328 NONE | Other services Service code 49 | 80 EIGHTH AVE NEW YORK, NY 10011 | $6K |
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 | 5,337 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 672 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 6,009 | 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."
Self-funded plan with no stop-loss carrier attached. Catastrophic-risk exposure; stop-loss specialist sales target.