| 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 | $123K | — | $123K | 6.20% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS EIN 23-7391136 CLAIMS ADMINISTRATOR | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $381K |
| MERCER EIN 13-2834414 ACTUARY | Actuarial Service code 11 | — | $33K |
| LCG ASSOCIATES, INC. EIN 75-1680350 THIRD-PARTY PROVIDER | Consulting (pension) Service code 17 | — | $32K |
| STATE STREET BANK AND TRUST COMPANY EIN 04-1867445 TRUSTEE | Trustee (directed) Service code 25 | — | $20K |
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 | 1,090 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,090 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 743 | $2.0M |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 743 | $2.0M |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS | 808 | $597K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 743 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 808 | — |
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.