Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingThe filing reports zero broker compensation on a plan over 100 participants. The plan likely buys direct or does not report its broker. Give it a call.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
Health | Health | |
Health | Health | |
Life | Life | |
Life | Life |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 5 contracts with Pro. Pro is free for 7 days and then costs $49 a month.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 235 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 235 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | HIGHMARK BLUECROSS BLUESHIELD OF WNY | 49 | $197K |
| Life insurance(2 contracts, 2 carriers) | METLIFE INSURANCE CO. | 235 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 235 | - |
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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HIGHMARK BLUECROSS BLUESHIELD OF WN EIN 16-1105741 CONTRACT ADMIN | Direct payment from the plan; Contract Administrator Service code 13 | — | $134K |
| TOWERS WATSON INVESTMENT SERVICES EIN 52-1868818 CONSULTANT | Direct payment from the plan; Consulting (general) Service code 16 | — | $18K |
| CVS CAREMARK EIN 05-0340626 CLAIMS PROCESSING | Direct payment from the plan; Claims processing Service code 12 | — | $11K |
| WELLINGTON EIN 04-2755549 INVESTMENT MGMT | Investment management; Investment management fees paid directly by plan Service code 28 | — | $5K |
| JP MORGAN CHASE BANK, N.A. EIN 13-4994650 TRUSTEE | Float revenue; Other investment fees and expenses; Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $3K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
8 contacts
Phone and email for the actuary and top hat administrator are on Pro.
10 filings · 2016 to 2025