| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 914 JUDSON ROAD LONGVIEW, TX 75601 | HIGHMARK WESTERN & NORTHEASTERN NEW YORK INC. | $23K | — | $23K | 3.55% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVUCES | 100 SUMMIT LAKE DR, SUITE 400 VAHALLA, NY 10595 | HIGHMARK NEW YORK | $6K | — | $6K | 4.02% |
| PAUL ROBILLARD AND ASSOCIATES3 Filed as: PAUL ROBILLARD & ASSOCIATES INC | 4536 MAIN STREET SUITE 100 AMHERST, NY 14226 | COMPANION LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 6.84% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | METROPOLITAN LIFE INSURANCE COMPANY | — | $500 | $500 | 2.37% |
| US INSURANCE SERVICES LLC3 | PO BOX 62937 VIRGINIA BEACH, VA 234662937 | METROPOLITAN LIFE INSURANCE COMPANY | — | $65 | $65 | 0.31% |
| PAUL ROBILLARD & ASSOC INC3 | 4536 MAIN ST, SUITE 100 AMHERST, NY 14226 | MUTUAL OF OMAHA INSURANCE COMPANY | $276 | — | $276 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WILLIAM GRACE EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $110K |
| KIMBERLY CORSARO EIN 16-0776158 EMPLOYEE | Employee (plan) Service code 30 | — | $48K |
| ARCARA LENDA EUSANIO & STACEY CPAS EIN 47-1793720 NONE | Accounting (including auditing) Service code 10 | — | $45K |
| JBM COMPUTER CONSULTANTS INC. EIN 16-1173118 NONE | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $26K |
| LIPSITZ GREEN SCIME & CAMBRIA EIN 16-0905097 NONE | Legal Service code 29 | — | $22K |
| WELLS FARGO EIN 34-1542819 NONE | Investment management; Custodial (securities) Service code 19 | — | $18K |
| PCA TECHNOLOGY GROUP, INC EIN 26-0022778 NONE | Consulting (general) Service code 16 | — | $8K |
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 | 662 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 184 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 846 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HIGHMARK WESTERN & NORTHEASTERN NEW YORK INC. | 76 | $811K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 79 | $21K |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 104 | $27K |
| Prescription drug | HIGHMARK WESTERN & NORTHEASTERN NEW YORK INC. | 76 | $653K |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 104 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 104 | — |
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.