| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | EXCELLUS BLUE CROSS BLUE SHIELD | $72K | — | $72K | 3.65% |
| ONEGROUP NY INC3 | 706 N. CLINTON STREET SYRACUSE, NY 13204 | GUARDIAN | $5K | — | $5K | 2.37% |
| PETER DERRENBACKER3 Filed as: PETER L DERRENBACKER | 34 ASPEN PARK BLVD EAST SYRACUSE, NY 13057 | GUARDIAN | $820 | — | $820 | 0.40% |
| PETER DERRENBACKER3 Filed as: PETER L DERRENBACKER | PO BOX 4718 SYRACUSE, NY 13221 | THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK | $29K | — | $29K | 14.56% |
| PETER DERRENBACKER3 Filed as: PETER L DERRENBACKER | 34 ASPEN PARK BLVD E SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $5K | $1K | $7K | 3.52% |
| RP DODD GROUP INC3 | 34 ASPEN PARK BLVD E SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $1K | $104 | $1K | 0.68% |
| PETER DERRENBACKER3 Filed as: PETER L DERRENBACKER | PO BOX 4718 SYRACUSE, NY 13221 | FIRST UNUM LIFE INSURANCE COMPANY | $26K | — | $26K | 19.97% |
| ONEGROUP NY INC3 | 706 N. CLINTON STREET SYRACUSE, NY 13204 | HM LIFE INSURANCE COMPANY OF NEW YORK | $0 | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRIME PAY EIN 03-0608841 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 1487 DUNWOODY DRIVE WEST CHESTER, PA 19380 | $17K |
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 | 390 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 392 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 241 | $2.0M |
| Dental | GUARDIAN | 196 | $207K |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK | 240 | $22K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN | 355 | $408K |
| Long-term disability | NORTHWESTERN MUTUAL | 386 | $189K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 241 | $2.0M |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 97 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 386 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.