| 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 | $13K | $54K | 13.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES EIN 22-0999690 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $1.5M |
| MILLIMAN INC EIN 91-0675641 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $229K |
| LABOR FIRST, LLC EIN 06-1750191 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $203K |
| DISTRICT 1199J PENSION PLAN EIN 22-3095464 AFFLIATED BENEFIT FUND | Other services; Direct payment from the plan Service code 49 | — | $184K |
| MICHELE KAMAL EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $125K |
| SELE DENT EIN 11-3310187 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $104K |
| DONNA HUGHES EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $101K |
| YEMISI ABIONA EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $98K |
| BARBARA SMALL EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $97K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $89K |
| MARIBEL NEGRON EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| JERRY VITA EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $79K |
| OXFELD COHEN PC EIN 01-0725849 NONE | Legal; Direct payment from the plan Service code 29 | — | $76K |
| FOX ROTHSCHILD LLP EIN 23-1404723 NONE | Legal; Direct payment from the plan Service code 29 | — | $76K |
| ROLANDO Y HONG, MD EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $61K |
| ROSE ANN GONZALEZ EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $55K |
| KIM CARDELL EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $54K |
| EMPIRX HEALTH, LLC NONE | Direct payment from the plan; Contract Administrator Service code 13 | 155 CHESTNUT RIDGE RD. - SUITE 103 MONTVALE, NJ 07645 | $51K |
| MARIA LOPEZ EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $44K |
| MICHAEL PISANI EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $41K |
| EMILY ALVAREZ EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $40K |
| CHRISTINA PACHECO EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $40K |
| SYNTONIC SYSTEMS INC EIN 13-2925049 NONE | Other services; Direct payment from the plan Service code 49 | — | $38K |
| NYDIA BERDECIA-GRAUER EIN 22-3143027 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $30K |
| JENNIFER EBEL EIN 22-3143027 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $30K |
| PERFECT PRINTING SOLUTIONS, INC. EIN 46-1378840 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $20K |
| WELLS FARGO BANK EIN 41-0449260 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $20K |
| MSI TECHNOLOGIES, LLC EIN 22-3827881 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $12K |
| PAYCHEX INC EIN 16-1124166 NONE | Other services; Direct payment from the plan Service code 49 | — | $10K |
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 | 2,627 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,595 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 4,226 | $416K |
| Prescription drug | MEDCO CONTAINMENT LIFE INSURANCE CO. | 808 | $599K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE | 3,044 | $236K |
| Other | HARTFORD LIFE AND ACCIDENT | 4,226 | $416K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,226 | — |
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.