| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC. | 225 KENNETH DRIVE ROCHESTER, NY 14623 | GUARDIAN | $6K | — | $6K | — |
| GALLAGHER BENEFIT SERVICES, INC. Filed as: CONNOR & GALLAGHER | 750 WARRENVILLE RD #400 LISLE, IL 60532 | GUARDIAN | $3K | — | $3K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROUP ADMINISTRATORS, INC. EIN 36-3381052 NONE | Claims processing Service code 12 | — | $48K |
| INNOVATIVE CARE MANAGEMENT EIN 93-1087669 NONE | Other fees Service code 99 | — | $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. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | GUARDIAN | 135 | $0 |
| Short-term disability | GUARDIAN | 135 | $0 |
| Long-term disability | GUARDIAN | 135 | $0 |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE CO | 108 | $294K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.