| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 Filed as: FIDELITY HEALTH INSURANCE SVCS, LLC | 200 SEAPORT BLVD MALL ZONE V2B BOSTON, MA 02210 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SEC. LIFE INS. CO. OF NY | $6K | — | $6K | 14.22% |
| YORK INTERNATIONAL AGENCY LLC3 Filed as: YORK INTERNATIONAL AGENCY, LLC | 500 MAMARONECK AVE SUITE 220 HARRISON, NY 10528 | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SEC. LIFE INS. CO. OF NY | $73 | — | $73 | 0.17% |
| WORTHAM SAN ANTONIO INC3 Filed as: JOHN ARTHUR SCOTTI | TEAM SCOTTI 100 STANWIX ST PITTSBURGH, PA 15222 | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | $910 | $44 | $954 | 11.70% |
| MJ INSURANCE3 Filed as: VARIOUS AGENTS - SEE ATTACHMENT | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $869 | — | $869 | 10.71% |
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 | 565 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 28 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 603 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts, 2 carriers) | DELTA DENTAL OF NEW YORK | 766 | $342K |
| Vision | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SEC. LIFE INS. CO. OF NY | 663 | $44K |
| Life insurance(2 contracts, 2 carriers) | STANDARD OF NEW YORK | 574 | $245K |
| Short-term disability | AFLAC | 4 | $8K |
| Long-term disability | STANDARD OF NEW YORK | 574 | $52K |
| Other(2 contracts, 2 carriers) | STANDARD OF NEW YORK | 574 | $245K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 766 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.