| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | EXCELLUS BLUE CROSS BLUE SHIELD | $86K | — | $86K | 2.95% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $5K | $616 | $5K | 2.91% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | — | $1K | $1K | 0.67% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $12K | $627 | $13K | 6.94% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | — | $1K | $1K | 0.67% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $3K | $234 | $4K | 4.43% |
| GCG FINANCIAL LLC Filed as: ALERA GROUP INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | — | $553 | $553 | 0.68% |
| JEFFREY GREENBLOTT3 | 4232 EMERSON PLACE VESTAL, NY 13850 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | — | $1K | 4.76% |
| GREGORY L ULATOWSKI3 Filed as: GREGORY ULATOWSKI | 305 PLYMOUTH DRIVE SYRACUSE, NY 13206 | THE PAUL REVERE LIFE INSURANCE COMPANY | $501 | — | $501 | 1.93% |
| BERT VAN DER WERFF3 | PO BOX 43 ANNSVILLE, NY 13308 | THE PAUL REVERE LIFE INSURANCE COMPANY | $86 | $4 | $90 | 0.35% |
| FOUR POINTS INC3 | 8049 BARONY WOODS PITTSFORD, NY 14534 | THE PAUL REVERE LIFE INSURANCE COMPANY | $25 | — | $25 | 0.10% |
No Schedule C service providers reported on this filing.
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 | 179 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 33 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 143 | $2.9M |
| Dental | GUARDIAN | 144 | $185K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | 210 | $19K |
| Life insurance | GUARDIAN | 179 | $183K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 174 | $108K |
| Long-term disability | GUARDIAN | 179 | $183K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 143 | $2.9M |
| Other | GUARDIAN | 179 | $183K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 210 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.