| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OMNI MANAGED HEALTH, INC.3 Filed as: OMNI MANAGED HEALTH INC | 3877 FLATLANDS AVE 2ND FLOOR BROOKLYN, NY 11234 | EMBLEM HEALTH PLAN, INC. | $35K | $0 | $35K | 3.99% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INSURANCE SERVICES, INC | 1000 WOODBURY RD STE 403 WOODBURY, NY 117972530 | EMBLEM HEALTH PLAN, INC. | $0 | $18K | $18K | 2.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LT | 1000 WOODBURY RD STE 403 WOODBURY, NY 117972530 | EMBLEM HEALTH PLAN, INC. | $0 | $0 | $0 | 0.00% |
| PROFESSIONAL GROUP PLANS INC3 | 225 WIRELESS BLVD HAUPPAUGE, NY 117883914 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $5K | $5K | 6.63% |
| S D F ASSOCIATES3 Filed as: S D F ASSOCIATES 1991 LTD | 571 MCDONALD AVE STE 591 BROOKLYN, NY 112183807 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 4.17% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1000 WOODBURY RD STE 403 WOODBURY, NY 117972530 | PRINCIPAL LIFE INSURANCE COMPANY | $838 | $0 | $838 | 1.07% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INS SERVICES INC | 1000 WOODBURY RD STE 403 WOODBURY, NY 117972530 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $670 | $670 | 0.85% |
| YOEL WHITEHOUSE3 | 117 ARLINGTON AVE LAKEWOOD, NJ 087014210 | PRINCIPAL LIFE INSURANCE COMPANY | $786 | $0 | $786 | 6.40% |
| DONALD C SAVOY INC3 | 100 CROSSWAYS PARK DR W STE 10 WOODBURY, NY 117972012 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $517 | $517 | 4.21% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1000 WOODBURY RD STE 403 WOODBURY, NY 117972530 | PRINCIPAL LIFE INSURANCE COMPANY | $202 | $0 | $202 | 1.65% |
| FNA INSURANCE SERVICES INC3 Filed as: FNA INS SERVICES INC | 1000 WOODBURY RD STE 403 WOODBURY, NY 117972530 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $81 | $81 | 0.66% |
| THE DBL CENTER LTD3 | 155 PINELAWN RD STE 120 SOUTH MELVILLE, NY 11747 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $1K | $978 | $2K | 18.65% |
| PARAMOUNT STRATEGIES GROUP INC3 Filed as: PARAMOUNT ENROLLMENT SOLUTIONS INC | 1754 55TH STREET BROOKLYN, NY 11204 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 20.80% |
| TYLER PHILIP KRYSTOFIK3 | 11 THISTLE AVE GLENWOOD, NJ 07418 | THE PAUL REVERE LIFE INSURANCE COMPANY | $599 | $178 | $777 | 7.93% |
| PLATINUM ENROLLMENT SPECIALISTS3 | 100 CHALLENGER RD STE 105 RIDGEFIELD PARK, NJ 07660 | THE PAUL REVERE LIFE INSURANCE COMPANY | $591 | $0 | $591 | 6.03% |
| JASON LOUIS KOSCO3 | 31 JESSE CT MONTVILLE, NJ 07045 | THE PAUL REVERE LIFE INSURANCE COMPANY | $268 | $20 | $288 | 2.94% |
| CORPORATE HEALTH MANAGEMENT LLC3 | 8 SPRUCE ST APT 75 T NEW YORK, NY 10038 | THE PAUL REVERE LIFE INSURANCE COMPANY | $101 | $175 | $276 | 2.82% |
| ROSEMARY MILLER3 | 30 ORCHARD ST NORWALK, CT 06850 | THE PAUL REVERE LIFE INSURANCE COMPANY | $207 | $43 | $250 | 2.55% |
| BRYAN FISH3 Filed as: BRYAN SCHWARTZ | 211 BARTHOLF AVE POMPTON LAKES, NJ 07442 | THE PAUL REVERE LIFE INSURANCE COMPANY | $138 | $3 | $141 | 1.44% |
| ALFRED SANFORD3 | 6425 DREXEL ROAD PHILADELPHIA, PA 19151 | THE PAUL REVERE LIFE INSURANCE COMPANY | $104 | $0 | $104 | 1.06% |
| MOSHE REISMAN3 | 10 WEST END AVE APT 29D NEW YORK, NY 10023 | THE PAUL REVERE LIFE INSURANCE COMPANY | $83 | $0 | $83 | 0.85% |
| ERICA LEBRON3 | 1722 PURDY ST BRONX, NY 10462 | THE PAUL REVERE LIFE INSURANCE COMPANY | $75 | $0 | $75 | 0.77% |
| DAVID J MCCLELLAN3 | 118 ROYAL HORSE WAY REINHOLDS, PA 17569 | THE PAUL REVERE LIFE INSURANCE COMPANY | $20 | $9 | $29 | 0.30% |
| GAIL D RICHARDSON3 | 140 SOUTH LONG BEACH AVENUE FREEPORT, NY 11520 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.03% |
| SHARON J DAVIS-EDWARDS3 | 140 SOUTH LONG BEACH AVENUE FREEPORT, NY 11520 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.03% |
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EMBLEM HEALTH PLAN, INC. | 171 | $898K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 219 | $79K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 219 | $79K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 127 | $22K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 120 | $12K |
| Other(3 contracts, 3 carriers) | EMBLEM HEALTH PLAN, INC. | 171 | $910K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 219 | — |
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.