| 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 | $0 | $38K | 4.84% |
| KRISTINE KELLOGG3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $16K | $0 | $16K | 9.28% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $12K | $191 | $12K | 7.02% |
| ASHLEY GRANATO3 | 4 EASTERN PKWY AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $6K | $186 | $6K | 3.46% |
| MARIE TREAT3 | 314 S SEWARD AVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $31 | $1K | 0.88% |
| JON PICHE3 | 220 BALL RD HASTINGS, NY 13076 | THE PAUL REVERE LIFE INSURANCE COMPANY | $876 | $267 | $1K | 0.68% |
| LISA T GARRIGAN3 | 3257 WALKER RD AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $414 | $19 | $433 | 0.26% |
| MISTY L PHELAN3 | 3247 SCOTIA ST PORT CHARLOTTE, FL 33952 | THE PAUL REVERE LIFE INSURANCE COMPANY | $89 | $0 | $89 | 0.05% |
| KRISTINE KELLOGG3 | 8889 SOUTH SENECA STREET PO BOX 321 WEEDSPORT, NY 13144 | EXCELLUS BLUE CROSS BLUE SHIELD | $7K | $0 | $7K | 14.17% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DR AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $3K | $0 | $3K | 8.03% |
| DONALD H MATSON3 Filed as: DONALD MATSON | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | FIRST UNUM LIFE INSURANCE COMPANY | $4K | $0 | $4K | 15.00% |
| KRISTINE KELLOGG3 | 8889 SOUTH SENECA STREET PO BOX 321 WEEDSPORT, NY 13144 | EXCELLUS BLUE CROSS BLUE SHIELD | $789 | $0 | $789 | 9.30% |
| KRISTINE KELLOGG3 | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $236 | $166 | $402 | 5.10% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $302 | $14 | $316 | 4.01% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY INSURANCE INC | 123 PINE VALLEY DR MIDDLETOWN, DE 19709 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $64 | $0 | $64 | 0.81% |
| CYD M WYATT3 | 1011 N 49TH AVE OMAHA, NE 68132 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $11 | $0 | $11 | 0.14% |
| STEPHEN M HENSS LLC3 | 6 CHISEL CREEK DR LANDENBURG, PA 19350 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9 | $0 | $9 | 0.11% |
| ROBERT ELLIS3 | 11261 WRIGHT CIR OMAHA, NE 68144 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 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 | 145 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 90 | $963K |
| Dental | EXCELLUS BLUE CROSS BLUE SHIELD | 90 | $52K |
| Vision | EXCELLUS BLUE CROSS BLUE SHIELD | 76 | $8K |
| Life insurance(3 contracts, 2 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 137 | $225K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 8 | $8K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 90 | $788K |
| Other(2 contracts) | FIRST UNUM LIFE INSURANCE COMPANY | 137 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
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.