| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE STE 100 ROCHESTER, NY 14625 | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | $47K | — | $47K | 1.53% |
| KINSMAN REST CORP3 | 19 SEAMANS LN BREWSTER, MA 02631 | COMPANION LIFE INSURANCE COMPANY | $7K | — | $7K | 11.22% |
| JOSEPH PAUL IMPARATO3 | PO BOX 1620 EAST DENNIS, MA 02641 | COMPANION LIFE INSURANCE COMPANY | $3K | — | $3K | 3.78% |
| KINSMAN REST CORP3 | 19 SEAMANS LN BREWSTER, MA 02631 | MUTUAL OF OMAHA INSURANCE COMPANY | $7K | — | $7K | 11.21% |
| JOSEPH PAUL IMPARATO3 | PO BOX 1620 EAST DENNIS, MA 02641 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | — | $2K | 3.79% |
| KINSMAN REST CORP3 | 19 SEAMANS LN BREWSTER, MA 02631 | MUTUAL OF OMAHA INSURANCE COMPANY | $6K | — | $6K | 11.22% |
| JOSEPH PAUL IMPARATO3 | PO BOX 1620 EAST DENNIS, MA 02641 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | — | $2K | 3.78% |
| KINSMAN REST CORP3 | 19 SEAMANS LN BREWSTER, MA 02631 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | — | $1K | 11.22% |
| JOSEPH PAUL IMPARATO3 | PO BOX 1620 EAST DENNIS, MA 02641 | MUTUAL OF OMAHA INSURANCE COMPANY | $501 | — | $501 | 3.78% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GUARDIAN LIFE INSURANCE COMPANY EIN 13-5123390 CLAIMS ADMIN | Claims processing Service code 12 | — | $17K |
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 | 248 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 248 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | 349 | $3.2M |
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 248 | $66K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 248 | $61K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 248 | $50K |
| Prescription drug(2 contracts, 2 carriers) | HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | 349 | $3.2M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 248 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 349 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.