| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DANIEL NESSIM3 | 40 CUTTERMILL RD SUITE 205 GREAT NECK, NY 11021 | AETNA LIFE INSURANCE CO. | $49K | — | $49K | 3.63% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS | 225 WIRELESS BLVD 2ND FLOOR HAUPPAUGE, NY 11788 | AETNA LIFE INSURANCE CO. | $12K | — | $12K | 0.91% |
| WESTCHESTER BENEFIT GROUP3 Filed as: WESTCHESTER CUSTOM BENEFITS GROUP L | 500 SUMMIT LAKE DR STE 150 VALHALLA, NY 10595 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $5K | $12K | 7.71% |
| CUSTOM BENEFITS, INC.3 Filed as: CUSTOM BENEFITS INC | 500 SUMMIT LAKE DR STE 120 VALHALLA, NY 10595 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | — | $3K | 11.68% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 285 | $1.4M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 173 | $150K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 173 | $150K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 173 | $150K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 46 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.