| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R.L. EVANS COMPANY, INC.3 Filed as: THE EVANS AGENCY LLC | 1 GRIMSBY DRVIE HAMBURG, NY 14075 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $39K | $29K | $68K | 5.66% |
| CLYDE A STOCKEY3 | 1518 MIKE CT SHAKOPEE, MN 55379 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $11K | — | $11K | 0.89% |
| R.L. EVANS COMPANY, INC.3 Filed as: THE EVANS AGENCY LLC | 1 GRIMSBY DRIVE HAMBURG, NY 14075 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $3K | $6K | 2.25% |
| CLYDE A STOCKEY3 | 1518 MIKE CT SHAKOPEE, MN 55379 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $856 | — | $856 | 0.33% |
| CALVO'S INSURANCE UNDERWRITERS, INC3 Filed as: CALVO'S INSURANCE UNDERWROTERS, INC | PO BOX FJ HAGATNA, GU 96932 | TOKIO MARINE PACIFIC INSURANCE LTD | $3K | — | $3K | 2.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHNOW NY DBA BCBS OF WNY EIN 16-1105741 INSURANCE CO | Insurance services; Claims processing Service code 12 | — | $0 |
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 | 2,058 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 2,058 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TOKIO MARINE PACIFIC INSURANCE LTD | 21 | $132K |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,698 | $396K |
| Vision(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,698 | $396K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,825 | $1.2M |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,825 | $1.2M |
| Prescription drug | TOKIO MARINE PACIFIC INSURANCE LTD | 21 | $132K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 2,055 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,055 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.