| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | EXCELLUS BLUECROSS BLUESHIELD | $97K | — | $97K | 2.67% |
| PETER DERRENBACKER3 Filed as: PETER DARRENBACKER | 34 ASPEN PARK BLVD EAST SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $4K | $1K | $5K | 2.60% |
| ROBERT DERRENBACKER3 Filed as: ROBERT DARRENBACKER | 34 ASPEN PARK BLVD. EAST SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $1K | $310 | $2K | 0.85% |
| RP DODD GROUP INC3 | 34 ASPEN PARK BLVD EAST SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $1K | $105 | $1K | 0.67% |
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NM 13204 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | — | $12K | 6.74% |
| BENEFITS CONSULTING GROUP3 Filed as: BENEFITS CONSULTING GROUP, INC. | 706 N CLINTON STREET SYRACUSE, NY 13204 | VISION SERVICE PLAN (VSP) | $1K | — | $1K | 2.62% |
| ONEGROUP NY INC3 Filed as: ONEGROUP NY INC. | 706 N CLINTON STREET SYRACUSE, NY 13204 | VISION SERVICE PLAN (VSP) | $482 | — | $482 | 0.86% |
| GARY WELTMANN3 Filed as: GARY F. WELTMANN | P.O. BOX 59816 POTOMAC, MD 20859 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $2K | $8K | 20.48% |
| EXECUTIVE INSURANCE ADVISORS LLC3 Filed as: EXECUTIVE INS ADVISORS LLC | PO BOX 59816 POTOMAC, MD 20859 | METROPOLITAN LIFE INSURANCE COMPANY | $681 | — | $681 | 1.68% |
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS EIN 16-1171765 THIRD PARTY ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 115 CONTINUUM DRIVE LIVERPOOL, NY 13088 | $9K |
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 | 351 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 65 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 416 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 332 | $3.8M |
| Vision | VISION SERVICE PLAN (VSP) | 294 | $56K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 432 | $178K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 300 | $18K |
| Long-term disability | NORTHWESTERN MUTUAL | 433 | $194K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 332 | $3.6M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 432 | $219K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 433 | — |
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."
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.