| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: AP BENEFIT ADVISORS DBA ENV INSUR. | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | EXCELLUS BLUE CROSS BLUE SHIELD | $36K | — | $36K | 4.29% |
| ASSUREDPARTNERS4 Filed as: AP BENEFIT ADVISORS DBA ENV INSUR. | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | DELTA DENTAL OF NY | $3K | — | $3K | 5.00% |
| ASSUREDPARTNERS3 Filed as: AP BENEFIT ADVISORS DBA ENV INSUR. | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | FIDELITY SECURITY LIFE INSURANCE CO OF NEW YORK | $1K | — | $1K | 10.13% |
| AP BENEFIT ADVISORS, LLC Filed as: AP BENEFIT ADVISORS LLC | 90 JOHN MUIR DR AMHERST, NY 14228 | RENAISSANCE LIFE & HEALTH INS. CO OF AMERICA | $869 | — | $869 | 11.99% |
| ASSUREDPARTNERS Filed as: AP BENEFIT ADVISORS DBA ENV INSUR. | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | AMALGAMATED LIFE INSURANCE CO | $237 | — | $237 | 4.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NOVAK FRANCELLA, LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $9K |
| SATTER LAW FIRM EIN 47-2395830 NONE | Legal; Direct payment from the plan Service code 29 | — | $7K |
| TEAMSTERS LOCAL UNION NO. 1149 EIN 16-6045613 RELATED PARTY | Direct payment from the plan; Plan Administrator Service code 14 | — | $7K |
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 | 65 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 69 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 69 | $841K |
| Dental | DELTA DENTAL OF NY | 144 | $58K |
| Vision | FIDELITY SECURITY LIFE INSURANCE CO OF NEW YORK | 120 | $10K |
| Life insurance | RENAISSANCE LIFE & HEALTH INS. CO OF AMERICA | 61 | $7K |
| Long-term disability | AMALGAMATED LIFE INSURANCE CO | 30 | $6K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 69 | $841K |
| Other | RENAISSANCE LIFE & HEALTH INS. CO OF AMERICA | 61 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 144 | — |
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.