| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRITY UNDERWRITERS & BROKERS3 | 4914 WEST GENESSEE STREET CAMILLUS, NY 13031 | UNION LABOR LIFE INSURANCE COMPANY | $48K | — | $48K | 10.00% |
| JOHN H BLASCH3 Filed as: JOHN H. BLASCH | 71 BEECHWOOD LANE BERKELEY HEIGHTS, NJ 07922 | HARTFORD LIFE AND ACCIDENT | $33K | — | $33K | 11.63% |
| THE MAXON COMPANY3 Filed as: MAXON ADMINISTRATORS INC | 76 NORTH BROADWAY IRVINGTON, NY 10533 | HARTFORD LIFE AND ACCIDENT | — | $3K | $3K | 1.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DICKINSON GROUP LLC EIN 20-1241472 NONE | Claims processing; Direct payment from the plan; Contract Administrator; Actuarial; Other fees Service code 11 | — | $681K |
| ANTHEM BLUE CROSS EIN 23-7391136 NONE | Claims processing; Other services; Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $373K |
| SLEVIN & HART EIN 52-1708613 NONE | Legal; Direct payment from the plan Service code 29 | — | $147K |
| DD SERVICES, INC. EIN 11-2705346 NONE | Direct payment from the plan; Plan Administrator; Claims processing Service code 12 | — | $132K |
| AMERICAN HEALTH HOLDINGS, INC. EIN 31-1368946 NONE | Direct payment from the plan; Other services Service code 49 | — | $79K |
| ERIC OLYNIK EIN 11-3310062 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $49K |
| FRANK RAPPO EIN 11-3310062 TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $49K |
| COSTAROTHBORT CPAS LLC EIN 46-5286678 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $36K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $32K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 NONE | Legal; Direct payment from the plan Service code 29 | — | $28K |
| OVERTURE HEALTH CARE, LLC EIN 83-2696963 NONE | Other services; Direct payment from the plan Service code 49 | — | $27K |
| MAXORPLUS, LTD. EIN 75-2676894 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $27K |
| RAEL AND LETSON NONE | Direct payment from the plan; Other services Service code 49 | 16855 WEST BERNARDO DRIVE SUITE 340 SAN DIEGO, CA 92127 | $20K |
| REYNOLDS CONSULTING SERVICES EIN 20-1899564 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $18K |
| WILMINGTON TRUST EIN 16-1486454 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $2K |
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 | 994 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,009 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 982 | $282K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 982 | $282K |
| Stop-loss / reinsurancereinsurance | UNION LABOR LIFE INSURANCE COMPANY | 977 | $479K |
| Other | HARTFORD LIFE AND ACCIDENT | 982 | $282K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 982 | — |
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.