| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRITY UNDERWRITERS & BROKERS3 | 4914 WEST GENESSEE STREET CAMILLUS, NY 13031 | UNION LABOR LIFE INSURANCE COMPANY | $56K | — | $56K | 10.00% |
| JOHN H BLASCH5 Filed as: JOHN H. BLASCH | 71 BEECHWOOD LANE BERKELEY HEIGHTS, NJ 07922 | HARTFORD LIFE AND ACCIDENT | $33K | — | $33K | 12.39% |
| THE MAXON COMPANY3 Filed as: MAXON ADMINISTRATORS INC | 76 NORTH BROADWAY IRVINGTON, NY 10533 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 0.93% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DICKINSON GROUP LLC EIN 20-1241472 NONE | Claims processing; Other commissions; Direct payment from the plan; Other fees; Actuarial; Contract Administrator Service code 11 | — | $653K |
| ANTHEM BLUE CROSS EIN 23-7391136 NONE | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 13 | — | $433K |
| SLEVIN & HART EIN 52-1708613 NONE | Legal; Direct payment from the plan Service code 29 | — | $220K |
| DD SERVICES, INC. EIN 11-2705347 NONE | Direct payment from the plan; Claims processing; Plan Administrator Service code 12 | — | $182K |
| AMERICAN HEALTH HOLDINGS, INC. EIN 31-1368946 NONE | Direct payment from the plan; Other services Service code 49 | — | $80K |
| ERIC OLYNIK EIN 11-3310062 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $50K |
| FRANK RAPPO EIN 11-3310062 TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | — | $50K |
| COSTAROTHBORT CPAS LLC EIN 46-5286678 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $43K |
| CALIBRE CPA GROUP PLLC EIN 47-0900880 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $33K |
| RAEL AND LETSON EIN 94-1701048 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $31K |
| FIRST ACTUARIAL CONSULTING EIN 26-3842522 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $30K |
| MAXORPLUS EIN 75-2676894 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $28K |
| OVERTURE HEALTH CARE, LLC EIN 83-2696963 NONE | Direct payment from the plan; Other services Service code 49 | — | $27K |
| BARNES, IACCARINO & SHEPHERD LLP EIN 26-3858697 NONE | Legal; Direct payment from the plan Service code 29 | — | $25K |
| REYNOLDS CONSULTING SERVICES EIN 20-1899564 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $19K |
| SAGE ADVISORY SERVICES LTD CO. EIN 74-2798841 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $6K |
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 | 1,153 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,056 | $264K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 1,056 | $264K |
| Stop-loss / reinsurancereinsurance | UNION LABOR LIFE INSURANCE COMPANY | 1,142 | $561K |
| Other | HARTFORD LIFE AND ACCIDENT | 1,056 | $264K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,142 | — |
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.