| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| COMMERCIAL COVERAGE INC3 | PO BOX 5060 220 CHURCH AVE BALLSTON SPA, NY 12866 | FIRST UNUM LIFE INSURANCE COMPANY | $48K | — | $48K | 3.15% |
| MVP BENEFIT GROUP INCORPORATED3 | 625 STATE STREET SCHENECTADY, NY 12305 | HCC LIFE INSURANCE COMPANY | $5K | — | $5K | 10.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MVP EIN 14-1640868 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $420K |
| LCG ASSOCIATES, INC. EIN 75-1680350 THIRD-PARTY PROVIDER | Consulting (pension) Service code 17 | — | $27K |
| MERCER EIN 13-2834414 ACTUARY | Actuarial Service code 11 | — | $21K |
| STATE STREET BANK AND TRUST COMPANY EIN 04-1867445 TRUSTEE | Trustee (directed) Service code 25 | — | $18K |
| CARON & BLETZER, PLLC EIN 04-3499945 AUDITOR | Accounting (including auditing) Service code 10 | — | $15K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 956 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 196 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 1,152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 725 | $1.5M |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 725 | $1.5M |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 143 | $47K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 725 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 725 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.