No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SAV-RX PRESCRIPTION SERVICES EIN 86-1323040 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $126K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 10 | — | $57K |
| JAY SMITH EIN 51-6051034 EMPLOYEE | Plan Administrator; Employee (plan); Direct payment from the plan Service code 14 | — | $36K |
| CHRISTINA HERNANDEZ EIN 51-6051034 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $33K |
| THE SEGAL COMPANY EIN 13-1975125 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $29K |
| ALLIED BENEFIT SYSTEMS EIN 36-3086057 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing Service code 12 | — | $28K |
| ASHER, GITTLER & D'ALBA, LTD. EIN 36-2786883 NONE | Legal; Direct payment from the plan Service code 29 | — | $26K |
| INVESTMENT CONSULTING SERVICES, LLC EIN 32-0016703 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $16K |
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 | 1,008 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 33 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,041 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 52 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 52 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.