| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN BENEFITS GROUP, INC.3 | 2914 PINE AVE. NIAGARA FALLS, NY 14301 | BLUECROSS BLUESHIELD OF WESTERN NY | $50K | — | $50K | 2.48% |
| BUCK CONSULTANTS LLC3 | BOX 202617 DALLAS, TX 75320 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $6K | $6K | 1.37% |
| HOLLIS D SEGUR INC3 Filed as: HOLLIS D. SEGUR INC. | P.O. BOX 400 CHESHIRE, CT 06410 | ANTHEM HEALTH PLANS, INC. | $418 | — | $418 | 3.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SIBSON CONSULTING EIN 13-1835864 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $24K |
| WELLS FARGO BANK, N.A. NONE | Direct payment from the plan; Other fees; Custodial (other than securities); Shareholder servicing fees Service code 18 | 1248 O STREET MAC N8032-021 LINCOLN, NE 68508 | $1K |
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 | 5,285 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 434 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,719 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | BLUECROSS BLUESHIELD OF WESTERN NY | 329 | $2.1M |
| Dental(4 contracts, 4 carriers) | ALPHA DENTAL PROGRAM, INC. (DELTA DENTAL) | 229 | $71K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 10,015 | $518K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 4,369 | $2.0M |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,369 | $2.5M |
| Other(2 contracts, 2 carriers) | HEALTH AND HUMAN RESOURCE CENTER (AETNA) | 5,285 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,015 | — |
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."
No prospect flags tripped on this filing.