| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSUREDPARTNERS3 Filed as: ASSUREDPARTNERS NORTHEAST LLC | 71 MONROE AVENUE PITTSFORD, NY 14534 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $2K | $8K | 7.24% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NORTHEAST LLC | 90A JOHN MUR DR STE 100 AMHERST, NY 14228 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $2K | $5K | 14.90% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NORTHEAST LLC | 90A JOHN MUR DR STE 100 AMHERST, NY 14228 | MUTUAL OF OMAHA INSURANCE COMPANY | $25K | $2K | $26K | 106.28% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NORTHEAST, LLC | 90A JOHN MUR DR STE 100 AMHERST, NY 14228 | COMPANION LIFE INSURANCE COMPANY | $2K | $1K | $3K | 16.23% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS NORTHEAST, LLC | 90A JOHN MUR DR STE 100 AMHERST, NY 14228 | MUTUAL OF OMAHA INSURANCE COMPANY | $228 | $142 | $370 | 16.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 ADMIN | Claims processing Service code 12 | — | $76K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $64K |
| ASSUREDPARTNERS NORTHEAST, LLC (BON EIN 45-3443572 BROKER | Insurance agents and brokers Service code 22 | — | $28K |
| REVIVEHEALTH, INC. EIN 86-1279290 OTHER | Other services Service code 49 | — | $14K |
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 | 181 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $112K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 124 | $112K |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 181 | $21K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 87 | $36K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 158 | $25K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY | 93 | $302K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 181 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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.