| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | STANDARD SECURITY LIFE INSURANCE COMPANY OF NY | $69K | $0 | $69K | 15.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | HARTFORD LIFE AND ACCIDENT | $8K | $4K | $12K | 3.05% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | HARTFORD LIFE AND ACCIDENT | $6K | $1K | $8K | 5.86% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | VISION SERVICE PLAN | $2K | $0 | $2K | 3.62% |
| CRUMP LIFE INSURANCE SERVICES3 | 4250 CRUMS MILL RD HARRISBURG, PA 17112 | JOHN HANCOCK FINANCIAL SERVICES | $4K | $0 | $4K | 10.57% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | HARTFORD LIFE AND ACCIDENT | $4K | $311 | $5K | 16.09% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | GUARDIAN | $5K | $2K | $8K | 27.45% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST STE 200 SYRACUSE, NY 13204 | HARTFORD LIFE AND ACCIDENT | $2K | $149 | $2K | 18.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF PENNSYLVANIA INC | 100 MATSONFORD RD BLDG 5, STE 200 RADNOR, PA 19087 | NATIONAL UNION FIRE INS CO OF PITTSBURGH PA | $0 | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS INC EIN 16-1171765 THIRD PARTY ADMINSTRATOR | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | 115 CONTINUUM DR LIVERPOOL, NY 13088 | $163K |
| MULTIPLAN INC EIN 13-3068979 ADMINISTRATION | Contract Administrator Service code 13 | PO BOX 29395 NEW YORK, NY 10087 | $78K |
| LIFETIME BENEFIT SOLUTIONS EIN 16-1171765 STOP LOSS BROKER | Insurance agents and brokers Service code 22 | 115 CONTINUUM DRIVE LIVERPOOL, NY 13088 | $32K |
| PRIVATE HEALTHCARE SYSTEMS EIN 13-3068979 ADMINISTRATION | Contract Administrator Service code 13 | PO BOX 29380 NEW YORK, NY 10087 | $19K |
| CORPORATE CARE MANAGMENT EIN 16-1181119 ADMINSTRATION | Contract Administrator Service code 13 | 1 KATTELVILLE RD BINGHAMTON, NY 13901 | $8K |
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 | 473 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 480 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 420 | $28K |
| Vision | VISION SERVICE PLAN | 386 | $53K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 659 | $395K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 213 | $12K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 621 | $134K |
| Stop-loss / reinsurancereinsurance | STANDARD SECURITY LIFE INSURANCE COMPANY OF NY | 513 | $462K |
| Other(4 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 659 | $463K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 659 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.