| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HR BENEFIT ADVISORS3 Filed as: HR BENEFIT ADVISORS, LTD | 208 MILL STREET ROCHESTER, NY 14614 | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WESTERN NY | $42K | — | $42K | 2.30% |
| MICHAEL RICHARD COLAO3 Filed as: MICHAEL R. COLAO | 208 MILL STREET SUITE 400 ROCHESTER, NY 14614 | TUFTS ASSOCIATED HEALTH MAINTENANCE ORG. INC. | $25K | — | $25K | 2.29% |
| JOSEPH PAUL IMPARATO3 | 19 MIMOSA CIR PLYMOUTH, MA 02360 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $29K | — | $29K | 15.00% |
| LAURA SCHURMAN3 | M3 INSURANCE SOLUTIONS INC. 828 JOHN NOLEN DR MADISON, WI 53713 | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | $943 | — | $943 | 1.23% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY EIN 13-5123390 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $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 | 295 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 295 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WESTERN NY | 303 | $3.0M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 295 | $195K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 295 | $195K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 295 | $195K |
| Prescription drug(3 contracts, 3 carriers) | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WESTERN NY | 303 | $3.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.