| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE SEGAL COMPANY3 Filed as: SEGAL SELECT INSURANCE SERVICES INC | 333 WEST 34TH STREET NEW YORK, NY 10001 | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | $55K | — | $55K | 3.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC. EIN 23-7391136 NONE | Claims processing; Contract Administrator; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $8.0M |
| DELTA DENTAL OF NEW YORK EIN 11-1980218 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $443K |
| PROSKAUER ROSE LLP EIN 13-1840454 ATTORNEY | Legal Service code 29 | — | $327K |
| ADMINISTRATIVE SERVICES ONLY INC. EIN 11-2995970 NONE | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $267K |
| THE SEGAL COMPANY INC. EIN 13-1835864 CONSULTANT | Actuarial; Consulting (general) Service code 11 | — | $242K |
| WELLS FARGO BANK EIN 94-1347393 NONE | Custodial (securities) Service code 19 | — | $190K |
| SPIVAK LIPTON LLP EIN 13-3494495 ATTORNEY | Legal Service code 29 | — | $158K |
| TRIPLE S SALUD INC. EIN 66-0555677 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $120K |
| STATE STREET GLOBAL ADVISORS EIN 04-1867445 NONE | Custodial (other than securities); Investment management fees paid directly by plan; Custodial (securities); Soft dollars commissions Service code 18 | — | $115K |
| SCHULTHEIS & PANETTIERI LLP EIN 13-1577780 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $93K |
| KELLY PRESS INC. EIN 52-0975591 PRINTER & COPIER | Copying and duplicating Service code 36 | — | $91K |
| MEKETA INVESTMENT GROUP INC. EIN 04-2659023 NONE | Investment advisory (plan) Service code 27 | — | $36K |
| GOULD KOBRICK & SCHLAPP P.C. NONE | Legal Service code 29 | 3 PARK AVENUE NEW YORK, NY 10016 | $20K |
| SYNTONIC SYSTEMS INC. EIN 13-2925049 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $18K |
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 | 23,122 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 687 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 23,809 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRIPLE S SALUD, INC. | 351 | $30K |
| Vision | DAVIS VISION, INC. | 25,919 | $439K |
| Life insurance | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | 11,119 | $500K |
| Short-term disability | THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK | 11,119 | $500K |
| Prescription drug | TRIPLE S SALUD, INC. | 351 | $30K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | 17,866 | $1.9M |
| Other | TRIPLE S SALUD, INC. | 351 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 25,919 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.