| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN BLASCH | 71 BEECHWOOD LANE BERKELEY HEIGHTS, NJ 07922 | HARTFORD LIFE AND ACCIDENT | $42K | $22K | $64K | 15.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES EIN 22-0999690 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.6M |
| DISTRICT 1199J PENSION PLAN EIN 22-3095464 AFFLIATED BENEFIT FUND | Direct payment from the plan; Other services Service code 49 | — | $277K |
| LABOR FIRST, LLC EIN 06-1750191 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $217K |
| MILLIMAN INC EIN 91-0675641 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $127K |
| SELE DENT EIN 11-3310187 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $111K |
| MICHELE KAMAL EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $108K |
| DONNA HUGHES EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $105K |
| BARBARA SMALL EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $91K |
| EMPIRX HEALTH, LLC NONE | Contract Administrator; Direct payment from the plan Service code 13 | 155 CHESTNUT RIDGE RD. - SUITE 103 MONTVALE, NJ 07645 | $91K |
| YEMISI ABIONA EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $89K |
| OXFORD COHEN PC EIN 01-0725849 NONE | Legal; Direct payment from the plan Service code 29 | — | $78K |
| MARIBEL NEGRON EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| FOX ROTHSCHILD LLP EIN 23-1404723 NONE | Legal; Direct payment from the plan Service code 29 | — | $76K |
| JERRY VITA EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $73K |
| RUBY GRAHAM EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $64K |
| SHIRLEY SPRIGGS EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $57K |
| ROLANDO Y HONG, MD EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $53K |
| ROSE ANN GONZALEZ EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $52K |
| KIM CARDELL EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $51K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $43K |
| CHRISTINA PACHECO EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $43K |
| EMILY ALVAREZ EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $38K |
| MICHAEL PISANI EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $37K |
| SYNTONIC SYSTEMS INC EIN 13-2925049 NONE | Other services; Direct payment from the plan Service code 49 | — | $34K |
| NOVELLA ARRINGTON EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $31K |
| MSI TECHNOLOGIES, LLC EIN 22-3827881 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $30K |
| JENNIFER EBEL EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $29K |
| NYDIA BERDECIA-GRAUER EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $27K |
| WELLS FARGO BANK EIN 41-0449260 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $19K |
| PERFECT PRINTING SOLUTIONS, INC. EIN 46-1378840 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $19K |
| HEALTH MANAGEMENT SYSTEMS, INC. EIN 38-2686158 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $17K |
| PAYCHEX INC EIN 16-1124166 NONE | Other services; Direct payment from the plan Service code 49 | — | $9K |
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 | 2,698 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,655 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,353 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 4,337 | $421K |
| Prescription drug | MEDCO CONTAINMENT LIFE INSURANCE CO. | 878 | $610K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE | 3,215 | $231K |
| Other | HARTFORD LIFE AND ACCIDENT | 4,337 | $421K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,337 | — |
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.