| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUDSON VALLEY AGENCY3 | 800 WESTCHESTER AVE SUITE S522 RYE BROOK, NY 10573 | SUN LIFE AND HEALTH INSURANCE COMPANY | $742 | — | $742 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES INC EIN 22-0999690 PROVIDES SVC FOR REL EBP | Claims processing; Direct payment from the plan Service code 12 | — | $334K |
| ROBERT BLUMENFELD EIN 22-1461069 PLAN ADMINISTRATOR | Employee (plan); Plan Administrator; Direct payment from the plan Service code 14 | — | $250K |
| BRIAN MCCLOSKEY EIN 22-1461069 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $191K |
| BRIDGEWAY BENEFIT TECHNOLOGIES EIN 52-1796473 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Direct payment from the plan Service code 15 | — | $127K |
| THE SEGAL COMPANY (EASTERN STATES) EIN 13-1835864 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $124K |
| IVAN DIAZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $107K |
| DANIEL ECKERT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $106K |
| EDWARD MICHELS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $94K |
| EXPRESS SCRIPTS INC EIN 43-1420563 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $93K |
| COHEN, LEDER, MONTALBANO & CONNAUGH EIN 41-2044610 NONE | Direct payment from the plan; Legal Service code 29 | — | $92K |
| CARMEN HERNANDEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $78K |
| JEANETTE BORRERO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $76K |
| MARIA ESCRIBANO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $75K |
| DAVID W. NEW, PC EIN 22-2553368 NONE | Direct payment from the plan; Legal Service code 29 | — | $72K |
| DEBORAH NEGRON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $65K |
| JACQUELINE CARLSON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $62K |
| MARIA BETANCOURT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $62K |
| JENDA TECHNOLOGY LLC EIN 45-5401009 NONE | Direct payment from the plan; Other services Service code 49 | — | $60K |
| BEATRIZ DE JESUS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $58K |
| DIANA ROMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $56K |
| AMY L COULOTE EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $55K |
| ISMAURY LOPEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $55K |
| DANIEL BARRIENTOS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $54K |
| DAISY SANTIAGO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $52K |
| CHRISTINA MARTINEZ EIN 22-1460169 EMPLOYEE | Employee (plan) Service code 30 | — | $51K |
| ANTWANNA GODFREY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $49K |
| CARISSA MARTINEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $45K |
| DENISE ALLEN-PEREZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $42K |
| WEAVER & TIDWELL LLP EIN 75-0786316 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $38K |
| CHANGE HEALTHCARE SOLUTIONS LLC EIN 20-5716594 NONE | Direct payment from the plan; Other services Service code 49 | — | $21K |
| WEAVER C BARKSDALE AND ASSOC EIN 62-1217255 NONE | Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $20K |
| MORGAN STANLEY WEALTH MANAGEMENT EIN 26-4310632 NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $14K |
| FAIR HEALTH INC EIN 90-0524293 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $13K |
| AMALGAMATED BANK OF NEW YORK EIN 13-4920330 NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $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 | 517 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 601 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 1,781 | $83K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 20 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,781 | — |
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.