| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| EMPLOYEE BENEFIT CONCEPTS INC.3 Filed as: EMPLOYEE BENEFIT CONCEPTS, INC. | 295 MAIN ST., SUITE 200 BUFFALO, NY 14203 | INDEPENDENT HEALTH | $23K | — | $23K | 3.18% |
| CROWN BENEFITS GROUP, INC.3 | 2914 PINE AVE NIAGARA FALLS, NY 14301 | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | $6K | — | $6K | 3.26% |
| LAWLEY BENEFITS GROUP LLC3 Filed as: LAWLEY BENEFITS GROUP, LLC | 361 DELAWARE AVE BUFFALO, NY 14202 | GUARDIAN | $8K | $5K | $13K | 12.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PATRICIA LUM EIN 16-0834222 FUND ADMINISTRATOR | Employee (plan) Service code 30 | — | $58K |
| SHARON PORTER EIN 16-0834222 EMPLOYEE | Employee (plan) Service code 30 | — | $40K |
| MERRILL LYNCH EIN 13-5674085 NONE | Investment advisory (plan); Custodial (securities); Investment management Service code 19 | — | $30K |
| HUNTINGTON NONE | Custodial (securities); Investment management; Investment advisory (plan) Service code 19 | PO BOX 1558 DEPT EA 4E86 COLUMBUS, OH 43216 | $16K |
| LIPSITZ GREEN SCIME & CAMBRIA, LLP EIN 16-0905097 | Legal Service code 29 | — | $10K |
| BINATECH SYSTEM SOLUTIONS, INC EIN 10-0006810 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $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 | 207 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 48 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 89 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 344 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INDEPENDENT HEALTH | 268 | $729K |
| Dental | GUARDIAN | 191 | $105K |
| Life insurance | GUARDIAN | 191 | $105K |
| Prescription drug | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 35 | $175K |
| Other(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 191 | $280K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 268 | — |
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.