| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ZOLLER ASSOCIATES INC3 Filed as: ZOLLER AGENCY | 19 CAMPION RD NEW HARTFORD, NY 13412 | EXCELLUS BLUE CROSS BLUE SHIELD | $46K | — | $46K | 3.76% |
| WILLIAM S MATHIAS3 Filed as: WILLIAM S GALL | 19 CAMPION ROAD NEW HARTFORD, NY 13413 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 3.11% |
| ACRISURE LLC3 | 600 SYLVAN AVE SUITE 301 ENGLEWOOD CLIFFS, NJ 07632 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 1.12% |
| ALLIANCE ADVISORY GRP INC3 Filed as: ALLIANCE ADVISORY GRP INC. | 350 ESSJAY D #301 WILLIAMSVILLE, NY 14221 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $74 | — | $74 | 0.06% |
| ZOLLER ASSOCIATES INC3 Filed as: THE ZOLLER AGENCY INC | 19 CAMPION ROAD NEW HARTFORD, NY 13413 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.74% |
| WILLIAM S MATHIAS3 Filed as: WILLIAM S GALL | 26 BRAIRWOOD LN NEW HARTFORD, NY 13413 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| WILLIAM S MATHIAS3 Filed as: WILLIAM S GALL | 26 BRAIRWOOD LN NEW HARTFORD, NY 13413 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | — | $1K | 15.01% |
No Schedule C service providers reported on this filing.
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 | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 108 | $1.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 126 | $119K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 173 | $23K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 158 | $38K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 108 | $1.2M |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 173 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 173 | — |
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."
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.