| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONEGROUP NY INC3 Filed as: ONEGROUP NY, INC. | 706 N CLINTON STREET SYRACUSE, NY 13204 | EXCELLUS BLUECROSS BLUESHIELD | $112K | — | $112K | 2.41% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NY INC. | — | VISION SERVICE PLAN | $1K | — | $1K | 2.01% |
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | VISION SERVICE PLAN | $777 | — | $777 | 1.19% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST. STE 200 SYRACUSE, NY 13204 | CIGNA INSURANCE GROUP | $2K | — | $2K | 4.86% |
| ONEGROUP NY INC3 Filed as: ONEGROUP NY INC. | 706 N CLINTON STREET SYRACUSE, NY 13204 | CIGNA INSURANCE GROUP | $1K | — | $1K | 2.13% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM STREET SUITE 200 SYRACUSE, NY 13204 | CIGNA GROUP INSURANCE | $3K | — | $3K | 6.79% |
| ONEGROUP NY INC3 Filed as: ONEGROUP NY INC. | 706 N CLINTON STRET SYRACUSE, NY 13204 | CIGNA GROUP INSURANCE | $1K | — | $1K | 2.31% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC. | 500 PLUM STREET SUITE 200 SYRACUSE, NY 13204 | MUTUAL OF OMAHA | $2K | $3K | $5K | 11.45% |
| ONEGROUP NY INC3 Filed as: ONEGROUP NY INC. | 28 S VINE STREET HAZELTON, PA 18201 | MUTUAL OF OMAHA | $1K | — | $1K | 2.91% |
| JAMES R NELLIGAN & ASSOCIATES LLC3 Filed as: JAMES NELLIGAN ASSOCIATES | 1800 RTE 34 BLDG 4 WALL TOWNSHIP, NJ 07719 | MUTUAL OF OMAHA | $202 | — | $202 | 0.44% |
| MICHAEL L O'DONNELL3 Filed as: MICHAEL O'DONNELL | 133 HAZELHURST AVENUE N SYRACUSE, NY 13212 | PAUL REVERE LIFE INSURANCE COMPANY | $760 | — | $760 | 7.48% |
| SUSAN SMITH3 | 1216 LANDRUSH WAY BALDWINSVILLE, NY 13027 | PAUL REVERE LIFE INSURANCE COMPANY | $133 | — | $133 | 1.31% |
| BRIAN MCLAUCHLAN3 | 8214 CICERO MILLS ROAD CICERO, NY 13039 | PAUL REVERE LIFE INSURANCE COMPANY | $13 | — | $13 | 0.13% |
| STEPHEN JOSEPH JOYCE3 Filed as: STEPHEN JOESEPH JOYCE | 70 SARGENT DRIVE AMHERST, NY 14226 | PAUL REVERE LIFE INSURANCE COMPANY | $10 | — | $10 | 0.10% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN | 500 PLUM STREET SUITE 200 SYRACUSE, NY 13204 | CIGNA GROUP INSURANCE | $569 | — | $569 | 7.03% |
| ONEGROUP NY INC3 | 706 N CLINTON ST. SYRACUSE, NY 13204 | CIGNA GROUP INSURANCE | $403 | — | $403 | 4.98% |
| MICHAEL L O'DONNELL3 Filed as: MICHAEL O'DONNELL | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $144 | — | $144 | 6.02% |
| SUSAN SMITH3 | — | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $72 | — | $72 | 3.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM STREET SUITE 200 SYRACUSE, NY 13204 | CIGNA GROUP INSURANCE | $139 | — | $139 | 8.78% |
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | CIGNA GROUP INSURANCE | $98 | — | $98 | 6.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS, INC. ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 333 BUTTTERNUT DRIVE SYRACUSE, NY 13214 | $12K |
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 | 364 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 364 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 273 | $4.7M |
| Vision | VISION SERVICE PLAN | 231 | $65K |
| Life insurance(3 contracts, 2 carriers) | CIGNA INSURANCE GROUP | 364 | $59K |
| Short-term disability | MUTUAL OF OMAHA | 368 | $46K |
| Long-term disability | CIGNA GROUP INSURANCE | 255 | $49K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 273 | $4.7M |
| Other(3 contracts, 3 carriers) | PAUL REVERE LIFE INSURANCE COMPANY | 364 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 368 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.