| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | EXCELLUS BLUECROSS BLUESHIELD | $17K | — | $17K | 3.83% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 6.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MANNING & NAPIER, INC. EIN 16-0995763 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $123K |
| STEVE OSTRANDER EIN 16-0766976 FUND MANAGER | Employee (plan); Direct payment from the plan Service code 30 | — | $79K |
| BONADIO & CO., LLP EIN 16-1131146 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $64K |
| TRICIA MARCIANO EIN 16-0766976 BENEFIT SPECIALIST | Employee (plan); Direct payment from the plan Service code 30 | — | $41K |
| MICHAEL J. TOBIN, ATTY. EIN 16-1523639 NONE | Legal; Direct payment from the plan Service code 29 | — | $41K |
| MELISSA DEL PRETE EIN 16-0766976 ANNUITY SPECIALIST | Employee (plan); Direct payment from the plan Service code 30 | — | $36K |
| INNOVATIVE SOFTWARE SOLUTIONS, INC. EIN 23-2182079 NONE | Direct payment from the plan; Other services Service code 49 | — | $34K |
| BANK OF AMERICA EIN 94-1687665 NONE | Investment management fees paid directly by plan; Custodial (securities) Service code 19 | — | $32K |
| PORTIA SANDI EIN 16-0766976 FUND ACCOUNTANT | Employee (plan); Direct payment from the plan Service code 30 | — | $31K |
| PHOENIX GRAPHICS INC. NONE | Direct payment from the plan; Other services Service code 49 | 1525 EMERSON STREET ROCHESTER, NY 14606 | $14K |
| SYSTEMS OF NY, INC. NONE | Direct payment from the plan; Other services Service code 49 | 70 LINDEN OAKS, SUITE 120 ROCHESTER, NY 14625 | $12K |
| GALLAGHER BENEFIT SOLUTIONS INC. NONE | Direct payment from the plan; Consulting (general) Service code 16 | 100 MERIDIAN CENTRE BLVD., STE 100 ROCHESTER, NY 14618 | $10K |
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 | 724 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 123 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 847 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 175 | $575K |
| Dental | EXCELLUS BLUECROSS BLUESHIELD | 1,831 | $455K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 802 | $102K |
| Other | HARTFORD LIFE AND ACCIDENT | 802 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,831 | — |
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.