| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DANIEL BENNETT3 | 62 W ELIZABETH STREET SKANEATELES, NY 13152 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 8.88% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $86 | $86 | 0.11% |
| AFS AGENCY3 | 195 GENESEE ST. STE 210 UTICA, NY 13501 | HM LIFE INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 10.00% |
| DANIEL BENNETT3 Filed as: DANIEL G BENNETT | 250 S CLINTON STREET SUITE 300 SYRACUSE, NY 13027 | FIRST UNUM LIFE INSURANCE COMPANY | $4K | — | $4K | 15.00% |
| AFS AGENCY3 | 185 GENESEE STREET SUITE 210 UTICA, NY 13501 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 22.00% |
| ALLIANCE ADVISORY GRP INC3 Filed as: ALLIANCE ADVISORY GROUP, INC. | 600 DELAWARE AVENUE BUFFALO, NY 14202 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $225 | — | $225 | 1.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $187K |
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 | 660 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 72 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 732 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 273 | $14K |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK | 217 | $32K |
| Life insurance(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 660 | $102K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 660 | $77K |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 660 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 660 | — |
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.