| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UPSTATE FINANCIAL SERVICES | 2105 W GENESEE STREET SYRACUSE, NY 13219 | MVP HEALTHCARE | — | $66K | $66K | 3.48% |
| KALF INC3 | 800 LINDEN AVE ROCHESTER, NY 14625 | EXCELLUS HEALTH PLAN | $5K | — | $5K | 4.02% |
| UPSTATE FINANCIAL SERVICES Filed as: UPSTATE FINANCIAL | 2105 W GENESEE STREET SYRACUSE, NY 13219 | MVP HEALTHCARE | $750 | — | $750 | — |
| UPSTATE FINANCIAL SERVICES Filed as: UPSTATE FINANCIAL | 2105 WEST GENESEE STREET SUITE 115 SYRACUSE, NY 13219 | ULLICO LIFE INSURANCE | $6K | — | $6K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| KRIS WILLIAMSON EMPLOYEE | Plan Administrator Service code 14 | — | $55K |
| KARPUS INVESTMENT MANAGEMENT CONSULTANT | Legal Service code 29 | 183 SULLYS TRAIL PITTSFORD, NY 14354 | $53K |
| BLITMAN AND KING LEGAL COUNSEL | Accounting (including auditing) Service code 10 | 16 WEST MAIN STREET ROCHESTER, NY 14614 | $30K |
| MOYER AND ASSOCIATES PC ATTORNEY | Legal Service code 29 | 28 EAST MAIN STREET SUITE 900 ROCHESTER, NY 14614 | $22K |
| STOKES,VISCA,HUCKO & BARONE CPA,LLC EIN 47-4215313 AUDITOR | Accounting (including auditing) Service code 10 | 29 GOODWAY DRIVE ROCHESTER, NY 14623 | $19K |
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 | 1,383 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 319 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 921 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 13 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 2,636 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(19 contracts, 7 carriers) | MVP HEALTHCARE | 213 | $5.4M |
| Dental(7 contracts, 3 carriers) | EXCELLUS HEALTH PLAN | 460 | $1.5M |
| Vision | DAVIS VISION | 1,250 | $200K |
| Prescription drug(9 contracts, 3 carriers) | EXCELLUS HEALTH PLAN | 57 | $2.2M |
| Other | ULLICO LIFE INSURANCE | 255 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,250 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.