| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES G. PARKER INSURANCE3 Filed as: JAMES M SMITH | PO BOX 188 JAMESTOWN, NY 147020188 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $4K | — | $4K | 3.39% |
| ENV INSURANCE AGENCY LLC3 Filed as: ENV INSURANCE AGENCY, LLC | 7789 OSWEGO RD LIVERPOOL, NY 130902322 | VISION SERVICE PLAN | $2K | — | $2K | 2.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHNOW NEW YORK, INC. EIN 46-5476155 THIRD PARTY ADMINISTATOR | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | PO BOX 80 BUFFALO, NY 14240 | $837K |
| DELTA DENTAL OF NEW YORK EIN 11-1980218 THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | ONE DELTA DRIVE MECHANICSBURG, PA 17055 | $39K |
| ENV INSURANCE AGENCY EIN 16-1519815 BROKER | Insurance agents and brokers Service code 22 | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | $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 | 614 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 50 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 664 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 652 | $75K |
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 806 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 806 | — |
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.