| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRITY UNDERWRITERS & BROKERS3 Filed as: INTEGRITY UNDERWRITERS & BROKER | 4914 WEST GENESSEE STREET CAMILLUS, NY 13031 | FIDELITY SECURITY LIFE INSURANCE CO OF NY | $62K | — | $62K | 10.00% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BLVD, 2ND FL HAUPPAUGE, NY 11788 | HARTFORD LIFE AND ACCIDENT | $35K | — | $35K | 12.28% |
| THE MAXON COMPANY3 Filed as: MAXON ADMINISTRATORS INC | 76 NORTH BROADWAY IRVINGTON, NY 10533 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 1.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Contract Administrator; Float revenue Service code 12 | — | $565K |
| DICKINSON GROUP LLC EIN 20-1241472 NONE | Actuarial; Contract Administrator; Claims processing; Direct payment from the plan Service code 11 | — | $372K |
| DDS SERVICES INC EIN 11-2705346 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $161K |
| SLEVIN & HART EIN 52-1708613 NONE | Legal; Direct payment from the plan Service code 29 | — | $110K |
| AMERICAN HEALTH HOLDINGS, INC. EIN 31-1368946 NONE | Other services; Direct payment from the plan Service code 49 | — | $74K |
| ERIC OLYNIK EIN 11-3310062 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $45K |
| FRANK RAPPO EIN 11-3310062 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $45K |
| COSTAROTHBORT CPAS LLC EIN 46-5286678 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $37K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $33K |
| OVERTURE HEALTH CARE, LLC NONE | Other services; Direct payment from the plan Service code 49 | 15 LAGOON DRIVE SOUTH NORTH BEACH, NJ 08008 | $29K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 NONE | Legal; Direct payment from the plan Service code 29 | — | $23K |
| REYNOLDS CONSULTING SERVICES EIN 20-1899564 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $18K |
| CONFIDIO, LLC EIN 47-1826755 NONE | Other services; Direct payment from the plan Service code 49 | — | $13K |
| SAGE ADVISORY SERVICES | Direct payment from the plan; Investment advisory (plan) Service code 27 | 5900 SOUTHWEST PARKWAY AUSTIN, TX 78735 | $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 | 1,628 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,656 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 2,005 | $286K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 2,005 | $286K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE CO OF NY | 1,536 | $624K |
| Other | HARTFORD LIFE AND ACCIDENT | 2,005 | $286K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,005 | — |
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.