| 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 | $28K | — | $28K | 4.41% |
| KRISTINE A ZABRISKIE3 Filed as: KRISTINE L KELLOGG | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16K | — | $16K | 9.88% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $13K | $555 | $13K | 7.90% |
| ASHLEY GRANATO3 | 4 EASTERN PARKWAY AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6K | $296 | $7K | 4.06% |
| MARIE TREAT3 | 314 S SEWARD AVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $84 | $1K | 0.69% |
| LISA T GARRIGAN3 | 3257 WALKER ROAD AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $540 | $43 | $583 | 0.35% |
| JON PICHE3 | 220 BALL RD HASTINGS, NY 13076 | THE PAUL REVERE LIFE INSURANCE COMPANY | $539 | — | $539 | 0.32% |
| MISTY L PHELAN3 | 1237 DUTCH HILL ROAD TULLY, NY 13159 | THE PAUL REVERE LIFE INSURANCE COMPANY | $120 | — | $120 | 0.07% |
| MATSON & KELLOGG BENEFITS GROUP LLC3 | 8889 S SENECA ST WEEDSPORT, NY 13166 | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | $3K | — | $3K | 5.48% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DR AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 8.13% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | — | $3K | 15.00% |
| DONALD H MATSON3 | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 9.74% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY INSURANCE INC | 123 PINE VALLEY DR MIDDLETOWN, DE 19709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $75 | — | $75 | 0.76% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.48% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $13 | — | $13 | 0.13% |
| STEPHEN M HENSS LLC3 | 6 CHISEL CREEK DR LANDENBERG, PA 19350 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.10% |
| 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% |
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 | 157 | 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) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 137 | $819K |
| Dental | UNITED CONCORDIA INSURANCE COMPANY OF NEW YORK | 158 | $49K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 71 | $11K |
| Life insurance(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 141 | $51K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 94 | $643K |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 141 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 158 | — |
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.