| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENV INSURANCE AGENCY LLC | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | DELTA DENTAL OF NEW YORK | $29K | — | $29K | 1.52% |
| ENV INSURANCE AGENCY LLC | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | HCC LIFE INSURANCE COMPANY | $22K | — | $22K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| POMCO, INC. EIN 15-0381548 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $268K |
| MANNING & NAPIER ADVISORS, INC EIN 45-3328488 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $141K |
| DELTA DENTAL EIN 11-1980218 | Direct payment from the plan; Claims processing Service code 12 | — | $115K |
| BLITMAN AND KING EIN 16-1047304 NONE | Legal; Direct payment from the plan Service code 29 | — | $59K |
| LIFETIME BENEFIT SOLUTIONS EIN 16-1171765 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $33K |
| M&T EIN 16-0538020 NONE | Direct payment from the plan; Custodial (securities) Service code 19 | — | $28K |
| PRIVATE HEALTH CARE SYSTEMS EIN 13-3068979 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $22K |
| O'SULLIVAN ASSOCIATES EIN 22-1837827 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $21K |
| BONADIO & CO, LLP EIN 16-1131146 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $19K |
| SEGAL ADVISORS EIN 13-2646110 NONE | Investment advisory (plan); Direct payment from the plan Service code 27 | — | $10K |
| KIANKA AND ZOLLO, CPA'S EIN 27-1242975 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $9K |
| POMCO PLUS INC. EIN 45-0482796 NONE | Claims processing; Insurance services; Direct payment from the plan Service code 12 | — | $0 |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,799 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 268 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,067 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 1,843 | $146K |
| Dental | DELTA DENTAL OF NEW YORK | 2,110 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,110 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.