Form 5500 · Employee benefit plan · PEEKSKILL, NY
BOARD OF TRUSTEES P&S LOCAL 21 WELFARE FUND
The filing calls this plan PLUMBERS & STEAMFITTERS LOCAL 21 WELFARE FUND.
Public Form 5500 records show how BOARD OF TRUSTEES P&S LOCAL 21 WELFARE FUND of PEEKSKILL, NY, a construction employer, structures its employee benefits. Its broker of record is THE SEGAL COMPANY. Coverage is written through ANTHEM BLUE CROSS BLUE SHIELD and 3 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 13-4017983 · plan 501 · plan year 2025, filed Apr 14, 2026
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315 other employer plans in New York have policy years ending in June. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, life and stop-loss; the largest, with ANTHEM BLUE CROSS BLUE SHIELD, covers 450 people.
The filing declares health, life, dental, vision and disability. Dental, vision and disability appear with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
The medical plan carries stop-loss coverage: the filing reports the plan paying its own health claims, with insured protection against large ones.
Reported premium across the insured contracts is $2,810,600, with $62,247 in disclosed broker commissions — about 2.2% of premium.
The health contract's policy period ended in June, while at least one ancillary line's policy period ended in January. The plan is on a split renewal cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| THE NORTH RIVER INSURANCE COMPANY | — | 1,019 | Feb 1, 2025 | $1,131,836 | $45,273 |
| ANTHEM BLUE CROSS BLUE SHIELD | Health | 450 | Jul 1, 2025 | $1,292,865 | $16,974 |
| COMPANION LIFE INSURANCE COMPANY | Life | 1,025 | Jan 2, 2026 | $382,569 | $0 |
| MUTUAL OF OMAHA INSURANCE COMPANY | Life | 602 | Jan 2, 2026 | $3,330 | $0 |
| ANTHEM BLUE CROSS BLUE SHIELD | Health, Stop-loss | — | Jul 1, 2025 | — | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
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Renewal calendar
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