Form 5500 · Employee benefit plan · ROCHESTER, NY
NYSARC INC., MONROE COUNTY CHAPTER
The filing calls this plan NYSARC INC., MONROE COUNTY CHAPTER EMPLOYEE BENEFITS PLAN.
Public Form 5500 records show how NYSARC INC., MONROE COUNTY CHAPTER of ROCHESTER, NY, a health care and social assistance employer, structures its employee benefits. Its broker of record is BROWN & BROWN INS SVCS INC. Coverage is written through EXCELLUS BLUE CROSS BLUE SHIELD and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 16-0835172 · plan 520 · plan year 2024, filed Jul 30, 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
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 3 insured contracts covering health, dental and vision; the largest, with EXCELLUS BLUE CROSS BLUE SHIELD, covers 236 people.
Reported premium across the insured contracts is $2,685,726, with $89,852 in disclosed broker commissions — about 3.3% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
BROWN & BROWN INS SVCS INC is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
Two carriers split the book: EXCELLUS BLUE CROSS BLUE SHIELD and EYEMED VISION CARE.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD | Health | 236 | Jan 1, 2025 | $2,500,798 | $79,906 |
| EXCELLUS BLUE CROSS BLUE SHIELD | Dental | 272 | Jan 1, 2025 | $167,607 | $8,654 |
| EYEMED VISION CARE | Vision | 233 | Jan 1, 2025 | $17,321 | $1,292 |
Premium and claims on these contracts
EXCELLUS BLUE CROSS BLUE SHIELD, contract 00101250. For the contract year on this filing, the carrier reported $2,500,798 in premium earned and $3,794,895 in claims incurred. Dividing one by the other gives 152%.
EXCELLUS BLUE CROSS BLUE SHIELD, contract 00055312. For the contract year on this filing, the carrier reported $167,607 in premium earned and $141,321 in claims incurred. Dividing one by the other gives 84%.
- EXCELLUS BLUE CROSS BLUE SHIELD, contract 00101250 reported $441,462 in retention.
- EXCELLUS BLUE CROSS BLUE SHIELD, contract 00055312 reported $38,743 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
How this plan compares
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Renewal calendar
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