| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R.L. EVANS COMPANY, INC.3 Filed as: THE EVANS AGENCY, LLC | 1 GRIMSBY DRIVE HAMBURG, NY 14075 | UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK | $10K | — | $10K | 1.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DEBRA KORPOLINSKI EIN 16-1561710 EMPLOYEE | Employee (plan) Service code 30 | — | $134K |
| TRONCONI SEGARRA & ASSOCIATES LLP EIN 04-3728817 NONE | Accounting (including auditing) Service code 10 | — | $47K |
| BARBARA ZELLNER EIN 16-1561710 EMPLOYEE | Employee (plan) Service code 30 | — | $43K |
| ANDREA SHARP EIN 16-1561710 EMPLOYEE | Employee (plan) Service code 30 | — | $36K |
| BLITMAN AND KING, LLP EIN 16-1047304 NONE | Legal Service code 29 | — | $28K |
| THE EVANS AGENCY INC EIN 94-0734860 NONE | Consulting fees Service code 70 | — | $23K |
| UBS FINANCIAL SERVICES EIN 13-2638166 NONE | Investment advisory (plan); Other fees Service code 27 | — | $14K |
| PCA TECHNOLOGY GROUP INC. EIN 26-0022778 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $10K |
| FINDLEY EIN 34-1213174 NONE | Actuarial Service code 11 | — | $7K |
| JBM COMPUTER CONSULTANTS EIN 16-1173118 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $6K |
| M&T BANK EIN 16-0538020 NONE | Investment management; Custodial (securities) Service code 19 | — | $4K |
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 | 897 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 369 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,266 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WNY | 2,266 | $13.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,315 | $239K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,315 | $239K |
| Prescription drug | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WNY | 2,266 | $12.3M |
| Other(2 contracts, 2 carriers) | HEALTHNOW NEW YORK, INC. DBA BLUE CROSS BLUE SHIELD OF WNY | 2,266 | $12.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,266 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.