| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | P.O. BOX 843844 KANSAS CITY, MO 64184 | HARTFORD LIFE INSURANCE COMPANY | — | $19K | $19K | 2.96% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 WEST 47TH STREET, SUITE 600 KANSAS CITY, MO 64112 | HARTFORD LIFE INSURANCE COMPANY | — | $449 | $449 | 3.07% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 WEST 47TH STREET SUITE 600 KANSAS CITY, MO 64112 | HARTFORD LIFE INSURANCE COMPANY | — | $45 | $45 | 0.36% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: REUBEN WARNER ASSOCIATES | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | FEDERAL INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 600 KANSAS CITY, MO 64112 | FEDERAL INSURANCE COMPANY | $784 | — | $784 | 14.99% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | ZURICH AMERICAN LIFE INSURANCE COMPANY | $196 | — | $196 | 9.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHNOW NEW YORK INC. EIN 16-1105741 MEDICAL ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $338K |
| DELTA DENTAL OF NEW YORK EIN 11-1980218 DENTAL ADMINISTRATOR | Claims processing Service code 12 | — | $30K |
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 | 792 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 804 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (EYEMED) | 797 | $45K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 818 | $631K |
| Short-term disability(2 contracts) | HARTFORD LIFE INSURANCE COMPANY | 818 | $642K |
| Long-term disability(2 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 818 | $631K |
| Stop-loss / reinsurancereinsurance | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WESTERN NY | 1,414 | $538K |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE INSURANCE COMPANY | 966 | $649K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,414 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.