| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENV INSURANCE AGENCY LLC Filed as: ENV INSURANCE AGENCY, LLC | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | EXCELLUS BLUECROSS BLUESHIELD | $25K | — | $25K | 15.00% |
| DENNIS KIRBY | 3440 DENSMORE ROAD ALBION, NY 144119611 | AETNA LIFE INSURANCE COMPANY | $4K | — | $4K | 12.69% |
| ENV INSURANCE AGENCY LLC3 Filed as: ENV INSURANCE AGENCY, LLC | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | EXCELLUS BLUECROSS BLUESHIELD | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS EIN 15-0329043 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $172K |
| THE SEGAL CO. EIN 13-1835864 NONE | Accounting (including auditing); Direct payment from the plan; Consulting (pension) Service code 10 | — | $108K |
| BLITMAN & KING EIN 16-1047304 NONE | Direct payment from the plan Service code 50 | — | $76K |
| MINDY LACLAIR EIN 16-0760551 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $57K |
| BONADIO & CO. LLP EIN 16-1131146 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $46K |
| RICHARD ROWE EIN 16-0760551 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $38K |
| POMCO THIRD PARTY ADMINISTRATOR | Claims processing; Direct payment from the plan Service code 12 | 2425 JAMES STREET SYRACUSE, NY 13206 | $31K |
| 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 | — | $14K |
| TINA LUCCI EIN 16-0760551 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $13K |
| ENVISION PHARMACEUTICAL SERVICES EIN 90-1011712 THIRD PARTY ADMINISTRATOR | Claims processing; Direct payment from the plan Service code 12 | — | $11K |
| DAVIS VISION EIN 11-3051991 THIRD PARTY ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $9K |
| KARPUS INVESTMENT MANAGER | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | 183 SULLYS TRAIL PITTSFORD, NY 14534 | $9K |
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 | 357 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 357 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(3 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 354 | $0 |
| Vision(2 contracts) | DAVIS VISION | 1,057 | $93K |
| Life insurance | AETNA LIFE INSURANCE COMPANY | 0 | $28K |
| Stop-loss / reinsurancereinsurance(2 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 377 | $354K |
| Other | AETNA LIFE INSURANCE COMPANY | 0 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,057 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.