| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R C LAIN INC.3 | PO BOX 1117 PORT JERVIS, NY 12771 | SUN LIFE ASSURANCE COMPANY OF CANADA | $8K | — | $8K | 3.46% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS COMPANY | 899 CASSATT ROAD BERWYN, PA 19312 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | — | $3K | 1.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA EIN 06-6033492 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $141K |
| GIANCARLO PREZIOSO EIN 22-1594458 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $56K |
| MARY JO MIESZKUC EIN 22-1594458 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $53K |
| NILSA LAKE EIN 22-1594458 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $51K |
| CBIZ SAVITZ EIN 31-1582098 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $47K |
| PAUL A. MONTALBANO, ESQ., LLC EIN 04-3669184 ATTORNEY FOR LOCAL 701 | Legal; Direct payment from the plan Service code 29 | — | $45K |
| MSPC EIN 22-2951202 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $19K |
| MORGAN, LEWIS & BOCKIUS, LLP EIN 23-0891050 NONE | Legal; Direct payment from the plan Service code 29 | — | $18K |
| INNOVATIVE SOFTWARE SOLUTIONS, INC. EIN 23-2182079 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $17K |
| ROCCO MORONGELLO EIN 22-1594458 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $12K |
| ANTHONY SIDOTI EIN 22-1594458 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $11K |
| KEVIN J. DEMBINSKI, DMD EIN 22-2198817 NONE | Other services; Direct payment from the plan Service code 49 | — | $10K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Direct payment from the plan; Other services Service code 49 | — | $8K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Custodial (securities); Investment management fees paid directly by plan Service code 19 | — | $7K |
| NEPC, LLC NONE | Investment management fees paid directly by plan; Investment advisory (plan) Service code 27 | — | $5K |
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 | 260 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 107 | $80K |
| Short-term disability | THE UNION LABOR LIFE INSURANCE COMPANY | 107 | $80K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 260 | $231K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 107 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.