| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRITY UNDERWRITERS & BROKERS3 Filed as: INTEGRITY UNDERWRITERS AND BROKERS | 4914 WEST GENESEE STREET CAMILLUS, NY 13031 | HCC LIFE INSURANCE COMPANY | $35K | — | $35K | 10.00% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BLVD, 2ND FL HAUPPAUGE, NY 11788 | HARTFORD LIFE INSURANCE CO. | $18K | $3K | $20K | 13.42% |
| RUBENZAHL STANLEY3 | MAXON ADMINISTRATORS INC 76 NO BROADWAY IRVINGTON, NY 10533 | HARTFORD LIFE INSURANCE CO. | — | $2K | $2K | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DICKINSON GROUP LLC EIN 20-1241472 NONE | Actuarial; Direct payment from the plan; Contract Administrator Service code 11 | — | $464K |
| DDS SERVICES INC EIN 11-2705346 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $109K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 26-4310632 NONE | Custodial (securities); Investment advisory (plan); Securities brokerage; Other services; Direct payment from the plan; Other investment fees and expenses; Securities brokerage commissions and fees Service code 19 | — | $98K |
| SLEVIN & HART EIN 52-1708613 NONE | Legal; Direct payment from the plan Service code 29 | — | $80K |
| COSTAROTHBORT CPAS LLC EIN 46-5286678 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $32K |
| INFOCUS ADVISORS DBA HERITAGE RX EIN 90-0768729 NONE | Consulting fees; Direct payment from the plan Service code 50 | — | $26K |
| STEINBERG,STECKLER & PICCIURRO, PC EIN 13-2665700 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $25K |
| BARNES, LACCARINO & SHEPERD LLP NONE | Accounting (including auditing); Legal Service code 10 | 258 SAW MILL RIVER ROAD ELMSFORD, NY 10523 | $16K |
| ERIC OLYNIK NONE | Direct payment from the plan; Trustee (individual) Service code 20 | 50 CHARLES LINDBERGH BLVD UNIONDALE, NY 11553 | $12K |
| S.A. KOENIG & ASSOCIATES EIN 11-3141654 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $7K |
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 | 1,094 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE INSURANCE CO. | 994 | $149K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,041 | $346K |
| Other | HARTFORD LIFE INSURANCE CO. | 994 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,041 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.