| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KRISTINE KELLOGG3 | 8889 SOUTH SENECA STREET PO BOX 321 WEEDSPORT, NY 13144 | EXCELLUS BLUE CROSS BLUE SHIELD | $38K | — | $38K | 4.42% |
| KRISTINE A ZABRISKIE3 Filed as: KRISTINE L KELLOGG | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16K | — | $16K | 8.61% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12K | $3K | $15K | 7.81% |
| ASHLEY GRANATO3 | 4 EASTERN PARKWAY AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $5K | $78 | $5K | 2.57% |
| MARIE TREAT3 | 314 S SEWARD AVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 1.45% |
| LISA T GARRIGAN3 | 3257 WALKER ROAD AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $549 | $266 | $815 | 0.43% |
| JON PICHE | 212 HALEY ST WATERTOWN, NY 13601 | THE PAUL REVERE LIFE INSURANCE COMPANY | $303 | $46 | $349 | 0.18% |
| MISTY L PHELAN3 | 1237 DUTCH HILL ROAD TULLY, NY 13159 | THE PAUL REVERE LIFE INSURANCE COMPANY | $155 | — | $155 | 0.08% |
| DANIEL DENNIS3 | 8177 RT 90 MONTEZUMA, NY 13117 | THE PAUL REVERE LIFE INSURANCE COMPANY | $21 | — | $21 | 0.01% |
| FELICIA MORTIMER3 | 2643 HIGHLAND FRUIT FARM RD LYONS, NY 14489 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | — | $8 | 0.00% |
| MATSON & KELLOGG BENEFITS GROUP LLC3 | 8889 S SENECA ST WEEDSPORT, NY 13166 | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | $5K | — | $5K | 7.80% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DR AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | — | $3K | 7.08% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| CYNTHIA LERNER RUBIN3 Filed as: CYNTHIA P WHALEN | 123 PINE VALLEY DR MIDDLETOWN, DE 19709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $70 | — | $70 | 0.66% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | — | $39 | 0.37% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.12% |
| STEPHEN M HENSS LLC3 | 44 HERSHEY LANE PARKSBURG, PA 19365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.09% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT E ELLIS | 11261 WRIGHT CIRCLE OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| JON SCOTT SWARTZENDRUBER3 | 600 HWY 169 SOUTH MINNEAPOLIS, MN 55426 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | — | $1 | 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 | 147 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 49 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 147 | $1.1M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | 251 | $64K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 147 | $60K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 116 | $855K |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 147 | $60K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 251 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.