| 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 | $89K | — | $89K | 2.88% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $14K | $826 | $15K | 6.77% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $5K | $934 | $6K | 2.87% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | GUARDIAN | $4K | $465 | $4K | 4.39% |
| JEFFREY GREENBLOTT3 | 4232 EMERSON PLACE PO BOX 4743 VESTAL, NY 13850 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 8.63% |
| GREGORY L ULATOWSKI3 Filed as: GREGORY ULATOWSKI | 305 PLYMOUTH DRIVE PO BOX 4743 SYRACUSE, NY 13206 | THE PAUL REVERE LIFE INSURANCE COMPANY | $557 | — | $557 | 1.69% |
| BERT VAN DER WERFF3 | PO BOX 43 ANNSVILLE, NY 13471 | THE PAUL REVERE LIFE INSURANCE COMPANY | $228 | $72 | $300 | 0.91% |
| FOUR POINTS INC3 | 8049 BARONY WOODS PO BOX 4743 PITTSFORD, NY 13221 | THE PAUL REVERE LIFE INSURANCE COMPANY | $25 | — | $25 | 0.08% |
| ACRISURE LLC3 Filed as: HAYLOR, FREYER & COON | 300 S STATE STREET SUITE 1000 PO BOX 4743 SYRACUSE, NY 13221 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $14K | — | $14K | 64.95% |
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 | 274 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 30 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 304 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 198 | $3.1M |
| Dental | GUARDIAN | 207 | $214K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 288 | $22K |
| Life insurance | GUARDIAN | 274 | $215K |
| Short-term disability(2 contracts, 2 carriers) | GUARDIAN | 276 | $131K |
| Long-term disability | GUARDIAN | 274 | $215K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 198 | $3.1M |
| Other | GUARDIAN | 274 | $215K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.