| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ENV INSURANCE AGENCY LLC3 Filed as: ENV INSURANCE AGENCY, LLC | 7789 OSWEGO RD LIVERPOOL, NY 13090 | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | $1K | $0 | $1K | 3.77% |
| ENV INSURANCE AGENCY LLC3 Filed as: ENV INSURANCE AGENCY, LLC | 7789 OSWEGO RD LIVERPOOL, NY 13090 | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | $1K | — | $1K | 3.80% |
| ENV INSURANCE AGENCY LLC3 | 7789 OSWEGO ROAD LIVERPOOL, NY 13090 | GUARDIAN | $2K | $127 | $2K | 10.05% |
| ENV INSURANCE AGENCY LLC3 | 7789 OSWEGO RD LIVERPOOL, NY 13090 | HM LIFE INSURANCE COMPANY | $168 | — | $168 | 9.98% |
| ENV INSURANCE AGENCY LLC3 | 7789 OSWEGO RD LIVERPOOL, NY 13090 | HARTFORD LIFE AND ACCIDENT | $126 | — | $126 | 11.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MAUREEN LEIB EIN 16-1198780 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $51K |
| DEB POLITIS CONSULTANT | Direct payment from the plan; Consulting (general) Service code 16 | 731 JAMES STREET, SUITE 300 SYRACUSE, NY 13203 | $36K |
| BLITMAN & KING EIN 16-1047304 NONE | Legal; Direct payment from the plan Service code 29 | — | $31K |
| BONADIO & CO., LLP EIN 16-1131146 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $13K |
| MANNING & NAPIER ADVISORS, INC. EIN 16-0995763 NONE | Direct payment from the plan; Investment management Service code 28 | — | $10K |
| J.A. MARIANO AGENCY INSURANCE BROKER | Direct payment from the plan; Insurance agents and brokers Service code 22 | 679 LANDIS AVE ROSENHAYN, NY 08352 | $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 | 390 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 390 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(4 contracts, 4 carriers) | INDEPENDENT HEALTH | 336 | $81K |
| Vision | HM LIFE INSURANCE COMPANY | 37 | $2K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 14 | $1K |
| Prescription drug(3 contracts) | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 9 | $103K |
| Other(4 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 14 | $104K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 336 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.