| 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 13202 | EXCELLUS BLUE CROSS BLUE SHIELD | $77K | $0 | $77K | 3.33% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $0 | $7K | $7K | 5.03% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $4K | $0 | $4K | 2.96% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $10K | $0 | $10K | 7.44% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $0 | $7K | $7K | 4.96% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $0 | $3K | $3K | 5.34% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON INC | 300 S STATE STREET SUITE 1000 SYRACUSE, NY 13221 | GUARDIAN | $2K | $0 | $2K | 4.50% |
| JEFFREY GREENBLOTT3 | 4232 EMERSON PL VESTAL, NY 13850 | THE PAUL REVERE LIFE INSURANCE COMPANY | $617 | $0 | $617 | 3.64% |
| GREGORY ULATOWSKI3 | PO BOX 111 SHERBURNE, NY 13460 | THE PAUL REVERE LIFE INSURANCE COMPANY | $361 | $0 | $361 | 2.13% |
| BERT VAN DER WERFF3 | PO BOX 43 ANNSVILLE, NY 13308 | THE PAUL REVERE LIFE INSURANCE COMPANY | $51 | $0 | $51 | 0.30% |
| FOUR POINTS INC3 | 8049 BARONY WOODS PITTSFORD, NY 14534 | THE PAUL REVERE LIFE INSURANCE COMPANY | $25 | $0 | $25 | 0.15% |
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 | 160 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 121 | $2.3M |
| Dental | GUARDIAN | 125 | $137K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 196 | $14K |
| Life insurance | GUARDIAN | 160 | $137K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 160 | $72K |
| Long-term disability | GUARDIAN | 160 | $137K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 121 | $2.3M |
| Other | GUARDIAN | 160 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 196 | — |
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.