| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM FINANCIAL SERVICES, LLC3 | 2038 SARANAC AVE. LAKE PLACID, NY 12946 | EXCELLUS BCBS | $18K | — | $18K | 2.48% |
| BURNHAM FINANCIAL SERVICES, LLC3 | 2038 SARANAC AVE. LAKE PLACID, NY 129461177 | METROPOLITAN LIFE INSURANCE COMPANY | $13K | $520 | $14K | 11.41% |
| JEFFREY P. BURNHAM3 | 2038 SARANAC AVE LAKE PLACID, NY 12946 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 4.94% |
| BURNHAM FINANCIAL SERVICES, LLC3 Filed as: BURNHAM FINANCIAL SERVICES | 2038 SARANAC AVE LAKE PLACID, NY 12946 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $593 | $593 | 1.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE COTTONWOOD GROUP EIN 20-5250908 ACTUARY | Actuarial Service code 11 | — | $10K |
| COTTONWOOD ADVISORS EIN 20-4591722 INVESTMENT ADVISORS | Investment advisory (plan) Service code 27 | — | $8K |
| BENEFIT TRUST COMPANY EIN 43-1971558 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $6K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 268 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BCBS | 71 | $742K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $41K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $41K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 186 | $161K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $41K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 0 | $41K |
| Prescription drug | EXCELLUS BCBS | 71 | $742K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 186 | $161K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 186 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.