| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | EXCELLUS BLUE CROSS BLUE SHIELD | $99K | — | $99K | 3.40% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $54 | $3K | 3.07% |
| GALLAGHER BENEFIT SERVICES, INC.3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 600063009 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.15% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 111 SUPERIOR AVE E STE 1601 CLEVELAND, OH 441142522 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $16 | $16 | 0.02% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $3K | $750 | $4K | 5.25% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 100 MERIDIAN CENTRE BLVD SUITE 100 ROCHESTER, NY 14618 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $5K | $561 | $5K | 8.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 PLAN ADMINISTRATOR MEDICA | Claims processing Service code 12 | — | $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 | 382 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 283 | $2.9M |
| Vision | EYEMED VISION CARE/COMBINED INSURANCE COMPANY OF NEW YORK | 477 | $30K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 487 | $105K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 315 | $78K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 315 | $58K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 283 | $2.9M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 487 | $105K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 487 | — |
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.