| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| YORK INTERNATIONAL AGENCY LLC3 Filed as: YORK INTERNATIONAL AGENCY | 500 MAMARONECK AVE, STE 220 HARRISON, NY 10528 | DELTA DENTAL OF NEW YORK | $11K | — | $11K | 3.77% |
| YORK INTERNATIONAL AGENCY LLC3 | 500 MAMARONECK AVE, STE 220 HARRISON, NY 10528 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $4K | — | $4K | 1.65% |
| YORK INTERNATIONAL AGENCY LLC3 | 500 MAMARONECK AVE, STE 220 HARRISON, NY 10528 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 5.21% |
| YORK INTERNATIONAL AGENCY LLC3 Filed as: YORK INTERNATIONAL AGENCY, LLC | 500 MAMARONECK AVE HARRISON, NY 10528 | EYEMED VIS. CARE ON BEHALF OF FIDELITY SEC. LIFE INS. CO. OF NEW YORK | $2K | — | $2K | 4.94% |
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SVCS, LLC | 200 SEAPORT BLVD BOSTON, MA 02210 | EYEMED VIS. CARE ON BEHALF OF FIDELITY SEC. LIFE INS. CO. OF NEW YORK | $9 | — | $9 | 0.02% |
| USI INSURANCE SERVICES LLC3 | CORPORATE HEADQUARTERS PO BOX 62689 VIRGINIA BEACH, VA 23466 | EYEMED VIS. CARE ON BEHALF OF FIDELITY SEC. LIFE INS. CO. OF NEW YORK | -$1 | — | -$1 | -0.00% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $3K | $484 | $4K | 22.58% |
| YORK INTERNATIONAL AGENCY LLC3 Filed as: YORK INTERNATIONAL AGENCY | 500 MAMARONECK AVE, STE 220 HARRISON, NY 10528 | DELTA DENTAL OF NEW YORK | $380 | — | $380 | 2.27% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN ARTHUR SCOTTI | TEAM SCOTTI 100 STANWIX ST PITTSBURGH, PA 15222 | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | $579 | $27 | $606 | 8.49% |
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 | 541 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 32 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 5 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 578 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF NEW YORK | 690 | $316K |
| Vision | EYEMED VIS. CARE ON BEHALF OF FIDELITY SEC. LIFE INS. CO. OF NEW YORK | 597 | $37K |
| Life insurance(2 contracts, 2 carriers) | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | 494 | $241K |
| Short-term disability | AFLAC | 7 | $17K |
| Long-term disability | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | 494 | $50K |
| Other | AFLAC | 7 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 690 | — |
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.