| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | HIGHMARK WESTERN NEW YORK | $23K | — | $23K | 3.44% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | HIGHMARK WESTERN NEW YORK | $5K | — | $5K | 2.94% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | HIGHMARK WESTERN NEW YORK | $2K | — | $2K | 3.02% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | HIGHMARK WESTERN NEW YORK | $780 | — | $780 | 2.71% |
| 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% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $57 | $2K | 6.79% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | METROPOLITAN LIFE INSURANCE COMPANY | — | $521 | $521 | 2.03% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62937 VIRGINIA BEACH, VA 23466 | HIGHMARK WESTERN NEW YORK | $540 | — | $540 | 3.53% |
| PAUL ROBILLARD AND ASSOCIATES3 Filed as: PAUL ROBILLARD & ASSOCIATES INC | 4536 MAIN STREET SUITE 100 AMHERST, NY 14226 | MUTUAL OF OMAHA INSURANCE COMPANY | $320 | — | $320 | 10.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIAM GRACE EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $194K |
| MARIA MONTANTE EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $78K |
| ARCARA ZUCARELLI LENDA & ASSOC. CPA EIN 47-1793720 NONE | Accounting (including auditing) Service code 10 | — | $50K |
| KIMBERLY CORSARO EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $33K |
| JBM COMPUTER CONSULTANTS INC. EIN 16-1173118 NONE | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $19K |
| WELLS FARGO EIN 34-1542819 NONE | Custodial (securities); Investment management Service code 19 | — | $16K |
| LIPSTIZ GREEN SCIME & CAMBRIA EIN 16-0905097 NONE | Legal Service code 29 | — | $11K |
| ROBERT R. RADEL, ATTORNEY AT LAW NONE | Legal Service code 29 | 174 FRANKLIN ST. BUFFALO, NY 142023618 | $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 | 623 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 187 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 810 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 85 | $26K |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 125 | $29K |
| Prescription drug(6 contracts) | HIGHMARK WESTERN NEW YORK | 75 | $1.0M |
| Other(2 contracts, 2 carriers) | HIGHMARK WESTERN NEW YORK | 125 | $659K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.