| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MBL BENEFITS CONSULTING CORP3 Filed as: MBL BENEFIT CONSULTING CORPORATION | 323 WEST 39TH STREET, 11TH FLOOR NEW YORK, NY 10018 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $98K | $13K | $111K | 3.80% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INSURANCE SERVICES, INC. | 1000 WOODBURY ROAD, SUITE 403 WOODBURY, NY 11797 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $0 | $34K | $34K | 1.16% |
| WORLD INSURANCE ASSOCIATES LLC3 | 656 SHREWSBURY AVENUE, SUITE 200 TINTON FALLS, NJ 07701 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $28K | $0 | $28K | 0.95% |
| MBL BENEFITS CONSULTING CORP3 Filed as: MBL BENEFIT CONSULTING CORPORATION | 323 WEST 39TH STREET, 11TH FLOOR NEW YORK, NY 10018 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $11K | $0 | $11K | 7.23% |
No Schedule C service providers reported on this filing.
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 | 161 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 162 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 444 | $2.9M |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 444 | $2.9M |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 444 | $2.9M |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 295 | $146K |
| Short-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 295 | $146K |
| Long-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 295 | $146K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 444 | $2.9M |
| Other | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 295 | $146K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 444 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.