| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 100 CHICAGO, IL 606036115 | PRUDENTIAL | $0 | $38 | $38 | 0.05% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET. FL2 BOSTON, MA 021101700 | VISION SERVICE PLAN | $569 | $0 | $569 | 8.96% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE | 160 FEDERAL ST. FL2 BOSTON, MA 02110 | AFLAC | $979 | $0 | $979 | 22.51% |
| JASON SALLEMI3 | 302 MONROE ST. APT. 4B HOBOKEN, NJ 07030 | AFLAC | $582 | $0 | $582 | 13.38% |
| DENNIS FENNELL3 | 8 BELVOIR DR. WASHINGTONVILLE, NY 10992 | AFLAC | $233 | $0 | $233 | 5.36% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY R ORGERA | 14 WALL ST. STE 8C NEW YORK, NY 10005 | AFLAC | $162 | $0 | $162 | 3.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $1K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $1K |
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 | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 122 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HORIZON HEALTHCARE SERVICES, INC. | 88 | $976K |
| Dental(2 contracts, 2 carriers) | HORIZON HEALTHCARE SERVICES, INC. | 77 | $52K |
| Vision | VISION SERVICE PLAN | 62 | $6K |
| Life insurance | PRUDENTIAL | 109 | $78K |
| Long-term disability | PRUDENTIAL | 109 | $78K |
| Prescription drug | HORIZON HEALTHCARE SERVICES, INC. | 88 | $976K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL | 109 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 109 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.