| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DENNIS KIRBY | 3440 DENSMORE ROAD ALBION, NY 144119611 | AETNA LIFE INSURANCE COMPANY | $4K | — | $4K | 12.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS EIN 16-1171765 PROVIDER NETWORK | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $112K |
| THE SEGAL CO. EIN 13-1835864 NONE | Consulting (pension); Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $90K |
| BLITMAN & KING EIN 16-1047304 NONE | Legal; Direct payment from the plan Service code 29 | — | $89K |
| BONADIO & CO. LLP EIN 16-1131146 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $80K |
| TINA LUCCI EIN 16-0760551 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $59K |
| MINDY LACLAIR EIN 16-0760551 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $46K |
| PRIVATE HEALTHCARE SYSTEMS EIN 13-3068979 PROVIDER NETWORK | Direct payment from the plan; Contract Administrator Service code 13 | PO BOX 29380 NEW YORK, NY 10087 | $40K |
| ROXANNE LONE EIN 16-0760551 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $33K |
| MANNING & NAPIER ADVISORS, INC. EIN 16-0995736 INVESTMENT MANAGER | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $26K |
| PRONEXUS NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 171 SULLYS TRAIL PITTSFORD, NY 14534 | $23K |
| ENVISION PHARMACEUTICAL SERVICES THIRD PARTY ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $14K |
| EBS RMSCO, INC. EIN 13-3068979 BROKER - STOP LOSS | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $13K |
| KARPUS INVESTMENT MANAGER | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | 183 SULLYS TRAIL PITTSFORD, NY 14534 | $12K |
| HEALTH ECONOMICS EIN 16-1110678 THIRD PARTY ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $12K |
| CORPORATE CARE MANAGEMENT EIN 16-1181119 ADMINISTRATION | Contract Administrator; Direct payment from the plan Service code 13 | 1 KATTELVILLE ROAD BINGHAMTON, NY 13901 | $6K |
| DAVIS VISION EIN 11-3051991 THIRD PARTY ADMINISTRATOR | Claims processing; Direct payment from the plan Service code 12 | — | $6K |
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 | 377 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 377 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 94 | $500K |
| Dental | HEALTH ECONOMICS GROUP, INC. | 491 | $334K |
| Vision(2 contracts) | DAVIS VISION | 1,069 | $84K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 369 | $29K |
| Prescription drug(3 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 94 | $500K |
| Other(2 contracts, 2 carriers) | LIFETIME BENEFIT SOLUTIONS | 369 | $113K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,069 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.