| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBIN M. TOMASULA3 | 8660 SHERIDAN DRIVE WILLIAMSVILLE, NY 14221 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $422 | — | $422 | 1.05% |
| F. JAMES GINNANE3 | 300 CORPORATE PARKWAY, SUITE 210N AMHERST, NY 14226 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $239 | — | $239 | 0.60% |
| JOSEPH P. MICHAEL3 | 100 CORPORATE PKWY, SUITE 338 AMHERST, NY 14226 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $27 | — | $27 | 0.07% |
| THOMAS R. ZUGGER3 | 37 FRANKLIN STREET, SUITE 600 BUFFALO, NY 14202 | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | $7 | — | $7 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRINCIPAL LIFE INSURANCE COMPANY EIN 42-0127290 CONTRACT ADMINISTRATOR | Recordkeeping fees; Direct payment from the plan; Participant loan processing; Contract Administrator Service code 13 | 711 HIGH STREET DES MOINES, IA 50392 | $31K |
| GALLAGHER FIDUCIARY ADVISORS EIN 26-0516431 INVESTMENT ADVISOR | Investment advisory (plan); Direct payment from the plan Service code 27 | 310 GRANT STREET, SUITE 3000 PITTSBURGH, PA 15219 | $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 | 846 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 83 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 3 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 933 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY | 163 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 163 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.