| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD., #110 PITTSFORD, NY 14534 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 5.51% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $2K | — | $2K | 4.49% |
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD., #110 PITTSFORD, NY 14534 | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | $3K | — | $3K | 14.66% |
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD., #110 PITTSFORD, NY 14534 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $703 | — | $703 | 5.34% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $613 | — | $613 | 4.66% |
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD., #110 PITTSFORD, NY 14534 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $350 | — | $350 | 5.62% |
| HILB GROUP OF NEW ENGLAND3 | 2000 CHAPEL VIEW BLVD., STE. 240 CRANSTON, RI 02920 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $274 | — | $274 | 4.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MATRIX QUALITY CARE, INC. DBA ARAYA EIN 13-3848923 RX THIRD PARTY ADMIN | Contract Administrator; Other services; Claims processing Service code 12 | — | $200K |
| EMPIRE HEALTHCHOICE ASSURANCE EIN 23-7391136 THIRD PARTY ADMINISTRATO | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $84K |
| SKYLIGHTRX, LLC EIN 86-3750854 RX CONSULTANT | Claims processing; Insurance brokerage commissions and fees; Other commissions; Contract Administrator; Insurance agents and brokers Service code 12 | — | $4K |
| CONSILIARIUM GROUP LLC BROKER | Insurance agents and brokers; Other commissions; Insurance brokerage commissions and fees Service code 22 | 1250 PITTSFORD VICTOR RD. PITTSFORD, NY 14534 | $0 |
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 | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. | 54 | $20K |
| Life insurance | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 95 | $54K |
| Short-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 95 | $516 |
| Long-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 95 | $13K |
| Stop-loss / reinsurancereinsurance | US FIRE INSURANCE COMPANY | 200 | $128K |
| Other(3 contracts, 2 carriers) | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 579 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 579 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.