| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KRISTINE A ZABRISKIE3 Filed as: KRISTINE L KELLOGG | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $15K | $0 | $15K | 8.18% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $13K | $463 | $14K | 7.48% |
| ASHLEY GRANATO3 | 4 EASTERN PKWY AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8K | $350 | $8K | 4.30% |
| JON PICHE3 | 220 BALL RD HASTINGS, NY 13076 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $31 | $1K | 0.59% |
| MARIE TREAT3 | 314 S SEWARD AVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $561 | $0 | $561 | 0.30% |
| MISTY L PHELAN3 | 3247 SCOTIA ST PORT CHARLOTTE, FL 33952 | THE PAUL REVERE LIFE INSURANCE COMPANY | $74 | $0 | $74 | 0.04% |
| LISA T GARRIGAN3 | 21 N BRUNER ST HINSDALE, IL 60521 | THE PAUL REVERE LIFE INSURANCE COMPANY | $45 | $0 | $45 | 0.02% |
| KRISTINE KELLOGG3 | 8889 SOUTH SENECA STREET PO BOX 321 WEEDSPORT, NY 13144 | EXCELLUS BLUE CROSS BLUE SHIELD | $5K | $0 | $5K | 8.76% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DR AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $0 | $3K | 6.75% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $5K | $0 | $5K | 14.78% |
| KRISTINE KELLOGG3 | 8889 SOUTH SENECA STREET PO BOX 321 WEEDSPORT, NY 13144 | EXCELLUS BLUE CROSS BLUE SHIELD | $920 | $0 | $920 | 10.16% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $97 | $0 | $97 | 1.16% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY INSURANCE INC | 224 RED TAILED HAWK LANE MIDDLETOWN, DE 19709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $65 | $0 | $65 | 0.77% |
| KRISTINE A ZABRISKIE3 Filed as: KRISTINE L KELLOGG | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | $0 | $39 | 0.46% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | $0 | $12 | 0.14% |
| STEPHEN M HENSS LLC3 | 6 CHISEL CREEK DR LANDENBURG, PA 19350 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.11% |
| ROBERT E ELLIS3 | 11261 WRIGHT CIR OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.02% |
No Schedule C service providers reported on this filing.
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 | 172 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 174 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 140 | $193K |
| Dental | EXCELLUS BLUE CROSS BLUE SHIELD | 102 | $62K |
| Vision | EXCELLUS BLUE CROSS BLUE SHIELD | 84 | $9K |
| Life insurance(3 contracts, 2 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 157 | $268K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 8 | $8K |
| Other(4 contracts, 3 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 157 | $276K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 157 | — |
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.