| 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 | $10K | — | $10K | 3.43% |
| KISTLER TIFFANY BENEFITS3 Filed as: KISTLER TIFFANY BENEFITS COMPANY | 899 CASSATT ROAD BERWYN, PA 19312 | SUN LIFE ASSURANCE COMPANY OF CANADA | $4K | — | $4K | 1.47% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA EIN 06-6033492 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $152K |
| NILSA LAKE EIN 22-1594458 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $54K |
| MARY JO MIESZKUC EIN 22-1594458 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $53K |
| PAUL A. MONTALBANO, ESQ., LLC EIN 04-3669184 ATTORNEY FOR LOCAL 701 | Legal; Direct payment from the plan Service code 29 | — | $52K |
| GIANCARLO PREZIOSO EIN 22-1594458 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $51K |
| CBIZ SAVITZ EIN 31-1582098 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $46K |
| MORGAN, LEWIS & BOCKIUS, LLP EIN 23-0891050 NONE | Legal; Direct payment from the plan Service code 29 | — | $29K |
| MSPC EIN 22-2951202 ACCOUNTANT FOR LOCAL 701 | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $20K |
| 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 | — | $15K |
| ANTHONY SIDOTI EIN 22-1594458 TRUSTEE | Direct payment from the plan Service code 50 | — | $11K |
| ROCCO MORONGELLO 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 |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $10K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Other services; Direct payment from the plan Service code 49 | — | $8K |
| 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 | 270 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 272 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | THE UNION LABOR LIFE INSURANCE COMPANY | 96 | $76K |
| Short-term disability | THE UNION LABOR LIFE INSURANCE COMPANY | 96 | $76K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 271 | $303K |
| Other | THE UNION LABOR LIFE INSURANCE COMPANY | 96 | $76K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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."
No prospect flags tripped on this filing.