| 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 | $636 | — | $636 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES INC EIN 22-0999690 PROVIDES SVC FOR REL EBP | Contract Administrator Service code 13 | — | $387K |
| ROBERT BLUMENFELD EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $261K |
| BRIAN MCCLOSKEY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $194K |
| CHANGE HEALTHCARE SOLUTIONS LLC EIN 20-5716594 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $142K |
| THE SEGAL COMPANY (EASTERN STATES) EIN 13-1835864 PROVIDES SVC FOR REL EBP | Actuarial Service code 11 | — | $138K |
| BRIDGEWAY BENEFIT TECHNOLOGIES EIN 52-1796473 PROVIDES SVC FOR REL EBP | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $113K |
| IVAN DIAZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $108K |
| DANIEL ECKERT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $106K |
| EDWARD MICHELS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $90K |
| JEANETTE BORRERO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $74K |
| CARMEN HERNANDEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $73K |
| MARIA ESCRIBANO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $72K |
| DAVID W. NEW, PC EIN 22-2553368 PROVIDES SVC FOR REL EBP | Legal Service code 29 | — | $70K |
| DEBORAH NEGRON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $62K |
| MARIA BETANCOURT EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $60K |
| JACQUELINE CARLSON EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $59K |
| BEATRIZ DE JESUS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $56K |
| DIANA ROMAN EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $54K |
| DANIEL BARRIENTOS EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $53K |
| DAISY SANTIAGO EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $52K |
| JENDA TECHNOLOGY LLC EIN 45-5401009 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $50K |
| COHEN, LEDER, MONTALBANO & CONNAUGH EIN 41-2044610 PROVIDES SVC FOR REL EBP | Legal Service code 29 | — | $50K |
| DENISE ALLEN-PEREZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $49K |
| CHRISTINA MARTINEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $49K |
| ISMAURY LOPEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $47K |
| ANTWANNA GODFREY EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $46K |
| SARAH ABDALLA EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $43K |
| BUCHBINDER TUNICK & COMPANY EIN 13-1578842 PROVIDES SVC FOR REL EBP | Accounting (including auditing) Service code 10 | — | $39K |
| CARISSA MARTINEZ EIN 22-1461069 EMPLOYEE | Employee (plan) Service code 30 | — | $32K |
| BARKSDALE INVESTMENT MANAGEMENT EIN 62-1217255 PROVIDES SVC FOR REL EBP | Investment advisory (plan) Service code 27 | — | $26K |
| EXPRESS SCRIPTS INC EIN 43-1420563 PROVIDES SVC FOR REL EBP | Claims processing Service code 12 | — | $23K |
| FAIR HEALTH INC EIN 90-0524293 PROVIDES SVC FOR REL EBP | Consulting (general) Service code 16 | — | $9K |
| ATRIUM STAFFING LLC EIN 13-3957708 PROVIDES SVC FOR REL EBP | Other services Service code 49 | — | $7K |
| SEGAL SELECT INSURANCE | Insurance brokerage commissions and fees Service code 53 | — | $0 |
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 | 556 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 662 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,218 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | AMALGAMATED LIFE INSURANCE COMPANY | 1,222 | $81K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 21 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,222 | — |
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.