| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN BENEFITS GROUP, INC.3 | 2914 PINE AVE. NIAGARA FALLS, NY 14301 | HEALTHNOW NEW YORK, INC. DBA BLUECROSS BLUESHIELD OF WESTERN NY | $45K | — | $45K | 2.51% |
| HOLLIS D SEGUR INC3 Filed as: HOLLIS D. SEGUR INC. | P.O. BOX 400 CHESHIRE, CT 06410 | ANTHEM HEALTH PLANS, INC. | $437 | — | $437 | 1.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SIBSON CONSULTING EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $37K |
| WELLS FARGO BANK, N.A. NONE | Shareholder servicing fees; Other fees; Custodial (other than securities); Direct payment from the plan Service code 18 | 1248 O STREET MAC N8032-021 LINCOLN, NE 68508 | $8K |
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 | 5,257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 582 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,839 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | HEALTHNOW NEW YORK, INC. DBA BLUECROSS BLUESHIELD OF WESTERN NY | 330 | $2.0M |
| Dental(4 contracts, 4 carriers) | DELTA DENTAL INSURANCE COMPANY | 2,959 | $1.7M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 5,788 | $316K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 2,953 | $209K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 1,466 | $92K |
| Other(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS, INC. | 1,466 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,788 | — |
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.