| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | EXCELLUS BLUE CROSS BLUE SHIELD | $87K | $0 | $87K | 2.95% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $5K | $0 | $5K | 2.39% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $13K | $0 | $13K | 6.22% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $4K | $0 | $4K | 4.73% |
| JEFFREY GREENBLOTT3 | 609 EAST MAIN STREET ENDICOTT, NY 13770 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 5.99% |
| GREGORY L ULATOWSKI3 Filed as: GREGORY ULATOWSKI | 305 PLYMOUTH DRIVE SYRACUSE, NY 13206 | THE PAUL REVERE LIFE INSURANCE COMPANY | $956 | $5 | $961 | 3.88% |
| CODY BRANDON MANGALSINGH3 | 119 WESTCOMBE PARK WEST HENRIETTA, NY 14586 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16 | $58 | $74 | 0.30% |
| MATTHEW ROBERT ZAHN3 | 1895 HONEOYE FALLS 6 ROAD HONEOYE FALLS, NY 14472 | THE PAUL REVERE LIFE INSURANCE COMPANY | $30 | $0 | $30 | 0.12% |
| ANDREW CAMPIONE3 | 1483 STOWELL DR APT 8 ROCHESTER, NY 14616 | THE PAUL REVERE LIFE INSURANCE COMPANY | $14 | $2 | $16 | 0.06% |
| ANTHONY S ALMODOVAR3 Filed as: ANTHONY MANGIONE | 29 SISSON DRIVE ROCHESTER, NY 14623 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3 | $0 | $3 | 0.01% |
| FOUR POINTS INC3 | 119 WESTCOMBE PARK WEST HENRIETTA, NY 14586 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | — | $2 | 0.01% |
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 | 294 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 46 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 340 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 229 | $2.9M |
| Dental | GUARDIAN | 238 | $223K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK | 325 | $23K |
| Life insurance | GUARDIAN | 508 | $207K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 295 | $111K |
| Long-term disability | GUARDIAN | 508 | $207K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 229 | $2.9M |
| Other | GUARDIAN | 508 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 508 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.