| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD BLDG 200 STE 270 PITTSFORD, NY 14534 | EXCELLUS BLUE CROSS BLUE SHIELD | $12K | — | $12K | 4.42% |
| CONSILIARIUM GROUP LLC3 Filed as: CONSILIARIUM GROUP, LLC | 1250 PITTSFORD VICTOR RD BLDG 100 STE 110 PITTSFORD, NY 14534 | AETNA | $9K | — | $9K | 3.46% |
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD BLDG 200 STE 270 PITTSFORD, NY 14534 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $1K | $4K | 10.89% |
| CONSILIARIUM GROUP LLC3 | 1250 PITTSFORD VICTOR RD BDG 100 STE 110 PITTSFORD, NY 14534 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 12.00% |
| JENNIFER GRANEY3 | 1250 PITTSFORD VICTOR RD BLD 100 STE 110 PITTSFORD, NY 14534 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $337 | — | $337 | 1.39% |
| IMG5 | — | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $26 | $26 | 0.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMPSYCH EIN 35-3739783 EAP PROVIDER | Contract Administrator Service code 13 | — | $659 |
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 | 115 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 80 | $528K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 61 | $40K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 61 | $40K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 115 | $24K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 115 | $24K |
| Prescription drug(2 contracts, 2 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 80 | $528K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 115 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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.