| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | EXCELLUS BLUECROSS BLUESHIELD | $112K | — | $112K | 2.42% |
| PETER DERRENBACKER3 | 34 ASPEN PARK BLVD EAST SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $3K | $681 | $4K | 1.40% |
| RP DODD GROUP INC3 | 34 ASPEN PARK BLVD EAST SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $718 | $63 | $781 | 0.30% |
| ROBERT DERRENBACKER3 | 34 ASPEN PARK BLVD. EAST SYRACUSE, NY 13057 | NORTHWESTERN MUTUAL | $281 | $65 | $346 | 0.13% |
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NM 13204 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 6.75% |
| NATIONAL BENEFITS CENTER LLC3 | 1105 NORTH MARKET STREET SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $328 | — | $328 | 0.16% |
| ONEGROUP NY INC3 Filed as: ONEGROUP NY INC. | 706 N CLINTON STREET SYRACUSE, NY 13204 | VISION SERVICE PLAN | $2K | — | $2K | 3.42% |
| GARY WELTMANN3 Filed as: GARY F. WELTMANN | P.O. BOX 59816 POTOMAC, MD 20859 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | — | $14K | 36.23% |
| ONEGROUP NY INC3 | 706 N CLINTON STREET SYRACUSE, NY 13204 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 11.21% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 1105 NORTH MARKET STREET SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $31 | — | $31 | 0.16% |
| 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 | 333 BUTTERNUT DRIVE DEWITT, NY 13214 | $13K |
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 | 328 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 44 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 372 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 336 | $4.8M |
| Vision | VISION SERVICE PLAN | 319 | $58K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 455 | $210K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 312 | $19K |
| Long-term disability | NORTHWESTERN MUTUAL | 456 | $259K |
| Prescription drug(2 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 336 | $4.8M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 455 | $250K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 456 | — |
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.