| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROWN RISK MANAGEMENT, LLC3 | 221 SOUTH WARREN ST, SUITE 100 SYRACUSE, NY 13202 | SUN LIFE AND HEALTH INSURANCE COMPANY | $14K | — | $14K | 10.00% |
| CROWN RISK MANAGEMENT, LLC3 | 221 SOUTH WARREN STREET, SUITE 100 SYRACUSE, NY 13202 | SUN LIFE AND HEALTH INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| SKODINSKI INSURANCE LLC3 | 2212 LINCOLN WAY W MISHAWAKA, IN 465441617 | HUMANA | $700 | — | $700 | 2.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 TPA | Contract Administrator Service code 13 | 165 COURT STREET ROCHESTER, NY 14647 | $539K |
| CROWN RISK MANAGEMENT, LLC EIN 20-2318765 BROKER | Insurance agents and brokers Service code 22 | 221 SOUTH WARREN STREET, SUITE 100 SYRACUSE, NY 13202 | $46K |
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 | 1,264 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 58 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,322 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HUMANA | 11 | $25K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 1,264 | $405K |
| Short-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 401 | $143K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 323 | $41K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 702 | $88K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,264 | — |
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.