| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EDWARD CHICOSKI III3 Filed as: EDWARD CHICOSKI | 301 ALBANY TURNPIKE ALBANY, NY 06019 | HARTFORD LIFE & ACCIDENT | — | $5K | $5K | 8.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SAV-RX EIN 86-1323040 NONE | Other insurance fees and expenses; Direct payment from the plan; Claims processing Service code 12 | 224 NORTH PARK AVENUE PFREMONT, NE 68025 | $227K |
| PHOENIX BENEFIT ADMINISTRATORS LLC EIN 84-4000013 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 13 | 1000 WEST VALLEY ROAD SOUTHEASTERN, PA 19399 | $90K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Direct payment from the plan; Contract Administrator Service code 13 | 151 FARMINTON AVENUE HARTFORD, CT 06156 | $73K |
| ZENITH AMERICAN SOLUTIONS INC EIN 52-1590516 NONE | Contract Administrator; Direct payment from the plan Service code 13 | 302 KNIGHTS RUN AVENUE SUITE 1100 TAMPA, FL 33602 | $48K |
| MCKEOGH COMPANY EIN 23-3003375 NONE | Actuarial; Direct payment from the plan Service code 11 | 200 BARR HARBOR DRIVE WEST CONSHOHOCKEN, PA 19428 | $41K |
| CIGNA HEALTH & LIFE INSURANCE COMPA EIN 59-1031071 NONE | Non-monetary compensation; Other services; Direct payment from the plan; Contract Administrator; Float revenue; Participant communication Service code 13 | 10490 LITTLE PATUXENT PARKWAY COLUMBIA, MD 21044 | $31K |
| BACHELER & COMPANY, PC EIN 23-2978066 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 400 SOUTH KINGS HIGHWAY CHERRY HILL, NJ 08034 | $22K |
| MERANZE KATZ & GAUDIOSO EIN 23-2943773 NONE | Direct payment from the plan; Legal Service code 29 | 121 SOUTH BROAD STREET PHILADELPHIA, PA 19107 | $20K |
| INVESTMENT PERFORMANCE SERVICES EIN 58-2432390 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | 12 PENNS TRAIL SUITE 132 NEWTOWN, PA 18940 | $5K |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 131 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | HARTFORD LIFE & ACCIDENT | 180 | $59K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 180 | — |
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."
No prospect flags tripped on this filing.