| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 100 MERIDIAN CENTER BOULEVARD SUITE 100 ROCHESTER, NY 14618 | EXCELLUS BLUE CROSS BLUE SHIELD | $66K | $0 | $66K | 2.86% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE LLC | 777 CANAL VIEW BOULEVARD SUITE 100 ROCHESTER, NY 14623 | EXCELLUS BLUE CROSS BLUE SHIELD | $11K | $0 | $11K | 0.48% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 1 JERICHO PLAZA, SUITE 200 JERICHO, NY 11753 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $26K | $0 | $26K | 10.26% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $10K | $0 | $10K | 4.12% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $107 | $5K | 4.03% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60690 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1K | $1K | 0.91% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $731 | $83 | $814 | 0.68% |
No Schedule C service providers reported on this filing.
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 | 241 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 151 | $2.3M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 363 | $120K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 363 | $120K |
| Life insurance | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 241 | $249K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 241 | $249K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 241 | $249K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 151 | $2.3M |
| Other(2 contracts, 2 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 387 | $269K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 387 | — |
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.