Form 5500 · Employee benefit plan · WEBSTER, NY
CALVARY AUTOMATION SYSTEMS
The filing calls this plan CALVARY AUTOMATION HEALTH AND WELFARE BENEFIT PLAN.
CALVARY AUTOMATION SYSTEMS of WEBSTER, NY is a 306-participant manufacturing employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is PAYCHEX AGENCY, INC.. Coverage is written through EXCELLUS BLUE CROSS BLUE SHIELD and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 06-1468155 · plan 501 · plan year 2024, filed Jul 29, 2025
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3,536 other employer plans in New York have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with EXCELLUS BLUE CROSS BLUE SHIELD, covers 149 people.
Reported premium across the insured contracts is $2,417,208, with $100,494 in disclosed broker commissions — about 4.2% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in July. The plan is on a split renewal cycle.
PAYCHEX AGENCY, INC. is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including EXCELLUS BLUE CROSS BLUE SHIELD, SUN LIFE AND HEALTH INSURANCE COMPANY and METROPOLITAN LIFE INSURANCE COMPANY. EXCELLUS BLUE CROSS BLUE SHIELD writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD | Health | 149 | Jan 1, 2025 | $2,108,148 | $80,681 |
| SUN LIFE AND HEALTH INSURANCE COMPANY | Life, Disability | 239 | Jan 1, 2025 | $187,098 | $14,378 |
| METROPOLITAN LIFE INSURANCE COMPANY | Dental | 273 | Jan 1, 2025 | $104,969 | $3,736 |
| METROPOLITAN LIFE INSURANCE COMPANY | Vision | 255 | Aug 1, 2024 | $16,993 | $1,699 |
Premium and claims on this contract
EXCELLUS BLUE CROSS BLUE SHIELD, contract 00032818. For the contract year on this filing, the carrier reported $2,108,148 in premium earned and $1,721,876 in claims incurred. Dividing one by the other gives 82%.
- EXCELLUS BLUE CROSS BLUE SHIELD, contract 00032818 reported $351,240 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
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Renewal calendar
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