| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE ROLLINS AGENCY INC3 Filed as: THE ROLLINS AGENCY | 800 WESTCHESTER AVE SUITE N311 RYE BROOK, NY 10573 | SUN LIFE AND HEALTH INSURANCE COMPANY | $497 | — | $497 | 11.13% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | 1133 WESTCHESTER AVE SUITE S229 WHITE PLAINS, NY 10604 | SUN LIFE AND HEALTH INSURANCE COMPANY | $192 | — | $192 | 4.30% |
| HUDSON VALLEY AGENCY3 | 800 WESTCHESTER AVE SUITE S522 RYE BROOK, NY 10573 | SUN LIFE AND HEALTH INSURANCE COMPANY | $121 | — | $121 | 2.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES INC EIN 22-0999690 PROVIDES SVC FOR REL EBP | Contract Administrator Service code 13 | — | $330K |
| ROBERT BLUMENFELD EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $231K |
| CHANGE HEALTHCARE SOLUTIONS LLC EIN 20-5716594 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $222K |
| BRIAN MCCLOSKEY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $169K |
| THE SEGAL COMPANY EIN 13-1835864 PROVIDES SVC FOR REL EBP | Actuarial Service code 11 | — | $117K |
| IVAN DIAZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $97K |
| DANIEL ECKERT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $86K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 PROVIDES SVC FOR REL EBP | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $85K |
| HENRY BARDSLEY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $82K |
| NEW & KARFUNKEL P.C. EIN 22-2553368 PROVIDES SVC FOR REL EBP | Legal Service code 29 | — | $78K |
| EDWARD MICHAELS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $77K |
| COHEN, LEDER, MONTALBANO & CONNAUGH EIN 41-2044610 PROVIDES SVC FOR REL EBP | Legal Service code 29 | — | $69K |
| JEANETTE BORRERO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $66K |
| CARMEN HERNANDEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $64K |
| MARIA ESCRIBANO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $56K |
| DEBORAH NEGRON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $53K |
| MARIA BETANCOURT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $52K |
| JACQUELINE CARLSON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $52K |
| BEATRIZ DE JESUS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $49K |
| JUAN PENAFIEL EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $45K |
| SARAH ABDALLA EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $43K |
| DENISE ALLEN-PEREZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $43K |
| CHRISTINA MARTINEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $42K |
| WEAVER C BARKSDALE & ASSOCIATES EIN 62-1217255 PROVIDES SVC FOR REL EBP | Investment advisory (plan) Service code 27 | — | $42K |
| DANIEL BARRIENTOS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $41K |
| ANTWANNA GODFREY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $40K |
| JAMILLE MELVIN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $39K |
| DIANA ROMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $39K |
| BUCHBINDER TUNICK & COMPANY EIN 13-1578842 PROVIDES SVC FOR REL EBP | Accounting (including auditing) Service code 10 | — | $38K |
| TELISA HOLMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $36K |
| JENDA TECHNOLOGY LLC EIN 45-5401009 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $31K |
| JULIA BORRERO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $29K |
| BAHL & GAYNOR EIN 31-1297139 PROVIDES SVC FOR REL EBP | Investment advisory (plan) Service code 27 | — | $24K |
| ATRIUM STAFFING OF NJ PROVIDES SVC FOR REL EBP | Other services Service code 49 | 625 LIBERTY AVE, SUITE 200 PITTSBURGH, PA 15222 | $22K |
| EXPRESS SCRIPTS INC EIN 43-1420563 PROVIDES SVC FOR REL EBP | Claims processing Service code 12 | — | $21K |
| DAISY SANTIAGO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $20K |
| CYNTHIA GUZMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $16K |
| RUTH MONDALTO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $15K |
| TERELL SPAULDING EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $14K |
| MORGAN STANLEY WEALTH MANAGEMENT EIN 26-4310632 PROVIDES SVC FOR REL EBP | Investment advisory (plan) Service code 27 | — | $14K |
| OFFICE TEAM ROBERT HALF INTERNATION EIN 94-1648752 PROV SRVS REL ORG & EBP | Other services Service code 49 | — | $13K |
| FAIR HEALTH INC EIN 90-0524293 PROVIDES SVC FOR REL EBP | Consulting (general) Service code 16 | — | $8K |
| AMALGAMATED BANK EIN 13-4920330 PROVIDES SVC FOR REL EBP | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $7K |
| SEGAL SELECT INSURANCE | Insurance brokerage commissions and fees Service code 53 | — | $3K |
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 | 690 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 945 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,635 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 1,671 | $106K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 20 | $4K |
| Other(2 contracts, 2 carriers) | MHN SERVICES LLC | 742 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,671 | — |
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.