| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KRISTINE KELLOGG3 | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | EXCELLUS BLUE CROSS BLUE SHIELD | $27K | — | $27K | 4.70% |
| KRISTINE A ZABRISKIE3 Filed as: KRISTINE L KELLOGG | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $15K | — | $15K | 8.66% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12K | $1K | $13K | 7.45% |
| ASHLEY GRANATO3 | 4 EMMA ST AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5K | $10 | $5K | 2.60% |
| CHRISTINE MARIE HUNT3 | 900 COUNTY ROUTE 7 HANNIBAL, NY 13074 | THE PAUL REVERE LIFE INSURANCE COMPANY | $973 | — | $973 | 0.56% |
| LISA T GARRIGAN3 | 3257 WALKER ROAD AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $589 | — | $589 | 0.34% |
| DANIEL DENNIS3 | 8177 RT 90 MONTEZUMA, NY 13117 | THE PAUL REVERE LIFE INSURANCE COMPANY | $281 | $50 | $331 | 0.19% |
| MISTY L PHELAN3 | 1237 DUTCH HILL ROAD TULLY, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $259 | — | $259 | 0.15% |
| MARIE TREAT3 | 314 S SEWARD AVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | $1 | $3 | 0.00% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DR AUBURN, NY 13021 | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 5.88% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DR AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | — | $3K | 7.98% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $147 | $4 | $151 | 0.98% |
| CYNTHIA LERNER RUBIN3 Filed as: CYNTHIA P WHALEN | 123 PINE VALLEY DR MIDDLETOWN, DE 19709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | — | $64 | 0.42% |
| PRESTON ROBERTSON ENTERPRISES INC3 | 11659 BERRY HILL DR NORTH PORT, AL 35475 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $47 | — | $47 | 0.31% |
| DAVID J MCCLELLAN3 Filed as: DAVID E WYATT | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.06% |
| STEPHEN M HENSS LLC3 | 44 HERSHEY LANE PARKSBURG, PA 19365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | — | $9 | 0.06% |
| TODD BOOZER3 Filed as: TODD A. BOOZER | 2900 CAHABA ROAD BIRMINGHAM, AL 35223 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | — | $7 | 0.05% |
| SCOTT SWARTZENDRUBER3 | 600 HWY 169 SOUTH MINNEAPOLIS, MN 55426 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.03% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | — | $5 | 0.03% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| CHRISTINE MARIE HUNT3 | 900 COUNTRY ROUTE 7 HANNIBAL, NY 13074 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
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 | 129 | 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. |
| Total participants (= "Plan participants" tile) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 128 | $762K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | 52 | $48K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 135 | $41K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 103 | $572K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 135 | $41K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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.