| 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 | $627 | — | $627 | 15.00% |
| THE ROLLINS AGENCY INC3 Filed as: THE ROLLINS AGENCY | 800 WESTCHESTER AVE SUITE N311 RYE BROOK, NY 10573 | SUN LIFE AND HEALTH INSURANCE COMPANY | $98 | — | $98 | 2.34% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES INC EIN 22-0999690 PROVIDES SVC FOR REL EBP | Contract Administrator Service code 13 | — | $350K |
| ROBERT BLUMENFELD EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $238K |
| CHANGE HEALTHCARE SOLUTIONS LLC EIN 20-5716594 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $233K |
| BRIAN MCCLOSKEY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $180K |
| THE SEGAL COMPANY (EASTERN STATES) EIN 13-1835864 PROVIDES SVC FOR REL EBP | Actuarial Service code 11 | — | $120K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 PROVIDES SVC FOR REL EBP | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general) Service code 15 | — | $101K |
| IVAN DIAZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $99K |
| DANIEL ECKERT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $90K |
| EDWARD MICHELS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $83K |
| COHEN, LEDER, MONTALBANO & CONNAUGH EIN 41-2044610 PROVIDES SVC FOR REL EBP | Legal Service code 29 | — | $82K |
| NEW & KARFUNKEL P.C. EIN 22-2553368 PROVIDES SVC FOR REL EBP | Legal Service code 29 | — | $80K |
| JEANETTE BORRERO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $69K |
| MARIA ESCRIBANO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $68K |
| CARMEN HERNANDEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $67K |
| DEBORAH NEGRON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $56K |
| JACQUELINE CARLSON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $55K |
| MARIA BETANCOURT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $54K |
| BEATRIZ DE JESUS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $50K |
| DIANA ROMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $49K |
| JUAN PENAFIEL EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $48K |
| DENISE ALLEN-PEREZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $45K |
| TERELL SPAULDING EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $45K |
| DAISY SANTIAGO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $45K |
| JENDA TECHNOLOGY LLC EIN 45-5401009 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $45K |
| CHRISTINA MARTINEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $45K |
| DANIEL BARRIENTOS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $44K |
| ANTWANNA GODFREY 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 | — | $40K |
| JULIA BORRERO 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 |
| SARAH ABDALLA EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $33K |
| HENRY BARDSLEY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $29K |
| CARISSA MARTINEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $28K |
| EXPRESS SCRIPTS INC EIN 43-1420563 PROVIDES SVC FOR REL EBP | Claims processing Service code 12 | — | $23K |
| BAHL & GAYNOR EIN 31-1297139 PROVIDES SVC FOR REL EBP | Investment advisory (plan) Service code 27 | — | $20K |
| MORGAN STANLEY WEALTH MANAGEMENT EIN 26-4310632 PROVIDES SVC FOR REL EBP | Investment advisory (plan) Service code 27 | — | $14K |
| JAMILLE MELVIN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $12K |
| 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 | Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $7K |
| BOYD WATTERSON EIN 34-1922005 PROV SRVS REL ORG & EBP | Custodial (securities); Investment advisory (plan) Service code 19 | — | $7K |
| CYNTHIA GUZMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $5K |
| TELISA HOLMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $5K |
| 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 | 604 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 870 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,474 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 1,054 | $89K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 21 | $4K |
| Other | MHN SERVICES LLC | 712 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,054 | — |
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."
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.