| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 726 EXCHANGE STREET, STE 900 BUFFALO, NY 14210 | BLUECROSS BLUESHIELD OF WNY | $16K | — | $16K | 2.22% |
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS, INC. | 301 OHIO STREET, SUITE 250 BUFFALO, NY 14204 | BLUECROSS BLUESHIELD OF WNY | $10K | — | $10K | 1.32% |
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS, INC. | 301 OHIO STREET, SUITE 250 BUFFALO, NY 14204 | BLUECROSS BLUESHIELD OF WNY | $5K | — | $5K | 2.81% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 726 EXCHANGE STREET, STE 900 BUFFALO, NY 14210 | BLUECROSS BLUESHIELD OF WNY | $410 | — | $410 | 0.22% |
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS, INC. | 301 OHIO STREET, SUITE 250 BUFFALO, NY 14204 | BLUECROSS BLUESHIELD OF WNY | $2K | — | $2K | 2.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 726 EXCHANGE STREET, STE 900 BUFFALO, NY 14210 | BLUECROSS BLUESHIELD OF WNY | $165 | — | $165 | 0.22% |
| PAUL ROBILLARD AND ASSOCIATES3 Filed as: PAUL ROBILLARD & ASSOCIATES INC | 4536 MAIN STREET SUITE 100 AMHERST, NY 14226 | COMPANION LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS INC | 301 OHIO STREET, STE 250 BUFFALO, NY 142042514 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 4.03% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | METROPOLITAN LIFE INSURANCE COMPANY | $659 | $41 | $700 | 2.25% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 234661007 | METROPOLITAN LIFE INSURANCE COMPANY | — | $171 | $171 | 0.55% |
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS, INC. | 301 OHIO STREET, STE 250 BUFFALO, NY 14204 | BLUECROSS BLUESHIELD OF WNY | $945 | — | $945 | 3.20% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 726 EXCHANGE STREET, STE 900 BUFFALO, NY 14210 | BLUECROSS BLUESHIELD OF WNY | $75 | — | $75 | 0.25% |
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS, INC. | 301 OHIO STREET, STE 250 BUFFALO, NY 14204 | BLUECROSS BLUESHIELD OF WNY | $705 | — | $705 | 4.10% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 726 EXCHANGE STREET, STE 900 BUFFALO, NY 14210 | BLUECROSS BLUESHIELD OF WNY | $60 | — | $60 | 0.35% |
| PAUL ROBILLARD AND ASSOCIATES3 Filed as: PAUL ROBILLARD & ASSOCIATES INC | 4536 MAIN STREET SUITE 100 AMHERST, NY 14226 | MUTUAL OF OMAHA INSURANCE COMPANY | $374 | — | $374 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIAM GRACE EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $196K |
| GINA APPOLONEY EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $112K |
| MARIA MONTANTE EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $80K |
| ARCARA ZUCARELLI LENDA & ASSOC. CPA EIN 47-1793720 NONE | Accounting (including auditing) Service code 10 | — | $51K |
| LIPSITZ GREEN SCIME & CAMBRIA EIN 16-0905097 NONE | Legal Service code 29 | — | $35K |
| JBM COMPUTER CONSULTANTS INC. EIN 16-1173118 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $17K |
| WELLS FARGO EIN 34-1542819 NONE | Investment management; Custodial (securities) Service code 19 | — | $5K |
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 | 550 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 229 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 779 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 133 | $31K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 146 | $33K |
| Prescription drug(6 contracts) | BLUECROSS BLUESHIELD OF WNY | 110 | $1.2M |
| Other(3 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF WNY | 110 | $871K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.