| 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 BLUE CROSS BLUE SHIELD | $47K | — | $47K | 17.65% |
| FITZGIBBONS AGENCY, LLC3 Filed as: FITZGIBBONS AGENCY LLC | 44 E. BRIDGE STREET STE 1 PO BOX 2023 OSWEGO, NY 13126 | FIRST UNUM LIFE INSURANCE COMPANY | $9K | — | $9K | 3.72% |
| ONEGROUP NY INC3 Filed as: ONEGROUP NY INC. | 706 N CLINTON ST SYRACUSE, NY 13204 | VISION SERVICE PLAN | $2K | — | $2K | 3.20% |
| FITZGIBBONS AGENCY, LLC3 Filed as: FITZGIBBONS AGENCY LLC | 44 E BRIDGE ST STE 1 PO BOX 2023 OSWEGO, NY 13126 | FIRST UNUM LIFE INSURANCE COMPANY | $19K | — | $19K | 154.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 TPA | Claims processing Service code 12 | — | $68K |
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 | 649 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 659 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW YORK | 655 | $0 |
| Vision | VISION SERVICE PLAN | 609 | $65K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 885 | $244K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 885 | $244K |
| Stop-loss / reinsurancereinsurance | EXCELLUS BLUE CROSS BLUE SHIELD | 652 | $264K |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 885 | $257K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 885 | — |
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.