| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HR BENEFIT ADVISORS3 | 74 BROWNS RACE SUITE 200 ROCHESTER, NY 14614 | SUN LIFE AND HEALTH INSURANCE COMPANY | $5K | — | $5K | 10.18% |
| HR BENEFIT ADVISORS3 Filed as: HR BENEFIT ADVISORS LTD | 208 MILL STREET SUITE 400 ROCHESTER, NY 14614 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 6.34% |
| HR BENEFIT ADVISORS3 | 74 BROWNS RACE SUITE 200 ROCHESTER, NY 14614 | GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| HR BENEFIT ADVISORS3 Filed as: HR BENEFIT ADVISORS LTD | 208 MILL STREET SUITE 400 ROCHESTER, NY 14614 | HARTFORD LIFE INSURANCE O. | $113 | — | $113 | 15.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GUARDIAN LIFE INSURANCE COMPANY EIN 13-5123390 CLAIMS PROCESSING | Claims processing Service code 12 | — | $9K |
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 | 219 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 219 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INDEPENDENT HEALTH | 51 | $228K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY | 157 | $10K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 219 | $42K |
| Short-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 226 | $52K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 226 | $52K |
| Prescription drug | INDEPENDENT HEALTH | 51 | $228K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 231 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 231 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.