Form 5500 · Employee benefit plan · BRIARWOOD, NY
SAMARITAN DAYTOP VILLAGE, INC.
The filing calls this plan SAMARITAN DAYTOP VILLAGE, INC. SECTION 125 PLAN.
SAMARITAN DAYTOP VILLAGE, INC. of BRIARWOOD, NY insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is ONE GROUP NY INC. Coverage is written through EMBLEMHEALTH and 5 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 11-2635374 · plan 502 · plan year 2025, filed Aug 18, 2026
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3,536 other employer plans in New York have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
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 6 insured contracts covering health, dental, vision, life and disability; the largest, with EMBLEMHEALTH, covers 847 people.
Reported premium across the insured contracts is $10,422,151, with $185,854 in disclosed broker commissions — about 1.8% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in November. The plan is on a split renewal cycle.
ONE GROUP NY INC is the broker of record on 2 of the 6 contracts; the rest name a different broker or none.
6 carriers appear on the filing, including EMBLEMHEALTH, THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, CIGNA HEALTH AND LIFE INSURANCE COMPANY and TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY. EMBLEMHEALTH writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EMBLEMHEALTH | Health | 847 | Jan 1, 2026 | $9,338,940 | $129,297 |
| TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY | Life, Disability | 400 | Jan 1, 2026 | $154,692 | $23,244 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental, Vision | 671 | Jan 1, 2026 | $383,393 | $22,557 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 1,424 | Dec 1, 2025 | $514,144 | $10,756 |
| NATIONAL EAP, INC. | — | 1,635 | Jul 1, 2025 | $30,202 | $0 |
| FIRST UNUM LIFE INSURANCE COMPANY | Life | 5 | Jan 1, 2026 | $780 | — |
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. We publish company names only.
Other plans filed by this employer
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