| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANTHONY IACCARINO3 | 2739 WHITE SAGE DRIVE HENDERSON, NV 89052 | PRUDENTIAL LIFE | $11K | — | $11K | 17.66% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| C A SMITH EIN 51-0247782 NONE | Employee (plan); Direct payment from the plan Service code 30 | 330 MOTOR PKWY STE 307 HAUPPAUGE, NY 11788 | $62K |
| BLET GENERAL COMM. OF ADJUSTMENT EIN 11-2073596 RELATED ORGANIZATION | Direct payment from the plan Service code 50 | 330 MOTOR PARKWAY STE 307 HAUPPAUGE, NY 11788 | $54K |
| L A MARIOS EIN 51-0247782 NONE | Direct payment from the plan; Employee (plan) Service code 30 | 330 MOTOR PKWY STE 307 HAUPPAUGE, NY 11788 | $41K |
| BROWN & BROWN NY DBA FITZHARRIS &CO EIN 58-1510477 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | 333 EARLE OVINGTON BLVD STE 215 UNIONDALE, NY 11553 | $37K |
| GOULD, KOBRICK & SCHLAPP, PC EIN 13-3082707 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | 3 PARK AVENUE SUITE 1402 NEW YORK, NY 10016 | $24K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | 333 WEST 34TH STREET NEW YORK, NY 10001 | $21K |
| HOLM & OHARA, LLP EIN 13-3591118 NONE | Legal; Direct payment from the plan Service code 29 | 3 WEST 35TH STREET 9TH FLOOR NEW YORK, NY 10001 | $12K |
| JOHN CHEEK, CPA EIN 13-3491592 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 1421 QUARRY RD CALEDONIA, NY 14423 | $9K |
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 | 468 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 89 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AARP UNITED HEALTHCARE | 119 | $320K |
| Life insurance | PRUDENTIAL LIFE | 559 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 559 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.