| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROSE & KIERNAN INC3 | 99 TROY RD, PO BOX 640 EAST GREENBUSH, NY 12061 | CAPITAL DISRICT PHYSICIAN'S HEALTH PLAN INC | $37K | $0 | $37K | 3.15% |
| ROSE & KIERNAN INC3 | PO BOX 640 99 TROY RD EAST GREENBUSH, NY 12061 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $4K | $8K | 7.27% |
| BETH SERFILIPPI3 | 8 HILLSTONE CT BALLSTON LAKE, NY 12019 | AFLAC | $836 | $16 | $852 | 4.11% |
| PAIGE HAMMOND3 | 5 BERKSHIRE DR EAST GREENBUSH, NY 12061 | AFLAC | $526 | $139 | $665 | 3.21% |
| ROSE & KIERNAN INC3 Filed as: ROSE AND KIERNAN INC | 99 TROY ROAD SUITE 3 EAST GREENBUSH, NY 12061 | AFLAC | $502 | $0 | $502 | 2.42% |
| JACQUELYN WILLIAMS0 | 136 SOUTH RD WHITEHALL, NY 12887 | AFLAC | $211 | $23 | $234 | 1.13% |
| EDMUND METZOLD3 | 1166 VAN CURLER AVE SCHENECTADY, NY 12308 | AFLAC | $131 | $0 | $131 | 0.63% |
| BENITO A ROTONDI II INC3 | 401 FRANKIN AVE SUITE 312 GARDEN CITY, NY 11530 | AFLAC | $97 | $0 | $97 | 0.47% |
| MELISSA ANN MURPHY3 | 36 WINCOMA LN QUEENSBURY, NY 12804 | AFLAC | $62 | $23 | $85 | 0.41% |
| MICHAEL LEFFLER3 | PO BOX 27 SAUGERTIES, NY 12477 | AFLAC | $58 | $5 | $63 | 0.30% |
| MELISSA ANN STEWART3 | 36 WINCOMA LN QUEENSBURY, NY 12804 | AFLAC | $58 | $0 | $58 | 0.28% |
| JANINE FOX3 Filed as: JANINE M FOX | 5303 HARMONY MILLS WEST COHOES, NY 12047 | AFLAC | $46 | $8 | $54 | 0.26% |
| SUSAN C BRIMHALL3 Filed as: SUSAN C BRINHALL | 3921 CAPE SAN BLAS RD PORT SAINT JOE, FL 32456 | AFLAC | $49 | $0 | $49 | 0.24% |
| DARRYL J YOUNG3 | 3820 GOLD CITY RD FRANKLIN, KY 42134 | AFLAC | $44 | $0 | $44 | 0.21% |
| GREGORY D GEMEREK3 | 25 CARRIAGE WAY BALLSTON SPA, NY 12020 | AFLAC | $41 | $0 | $41 | 0.20% |
| BRAD JONES AND ASSOCIATES INC3 | 19 BRITISH AMERICAN BLVD LATHAM, NY 12110 | AFLAC | $33 | $0 | $33 | 0.16% |
| SUSAN C BRIMHALL3 | 155 CYPRESS LN OLDSMAR, FL 34677 | AFLAC | $9 | $0 | $9 | 0.04% |
| DANIELLE M BRANCATO HOUSE3 Filed as: DANIELLE M BRANCATO | 347 USHERS ROAD BALLSTON LAKE, NY 12019 | AFLAC | $5 | $0 | $5 | 0.02% |
| KRISTA ANNE ROTONDI3 Filed as: KRISTA GRASSIA | 5 PINE WEST PLZ STE 503 ALBANY, NY 12205 | AFLAC | $4 | $0 | $4 | 0.02% |
| DANIELLE M BRANCATO HOUSE3 Filed as: DANIELLE M BRANCATO-HOUSE | 4 CRESTMONT DR CLIFTON PARK, NY 12065 | AFLAC | $2 | $0 | $2 | 0.01% |
| DUCK & COVER NY INC3 | 17 DALAMAR CT LATHAM, NY 12110 | AFLAC | $1 | $0 | $1 | 0.00% |
| KEVIN MCCARTHY3 | 197 LANG DR NORTH KINGSTOWN, RI 02852 | AFLAC | $1 | $0 | $1 | 0.00% |
| TOMAS E FLORES3 | 1265 15TH ST APT 16G FORT LEE, NJ 07024 | AFLAC | $1 | $0 | $1 | 0.00% |
| KELLY A IRVINE3 | 333 GLEN STREET SUITE 201 GLENS FALLS, NY 12801 | AFLAC | $1 | $0 | $1 | 0.00% |
| RUSSELL T BARRETT3 | 10 AZALEA DRIVE SARATOGA SPRINGS, NY 12866 | AFLAC | $1 | $0 | $1 | 0.00% |
| IRMA MATILDE WOODARD3 | 7684 STATE ROUTE 66 AVERILL PARK, NY 12018 | AFLAC | $1 | $0 | $1 | 0.00% |
| KEVIN MURPHY3 | 11 WILLOWBROOK TERRACE CLIFTON PARK, NY 12065 | AFLAC | $1 | $0 | $1 | 0.00% |
| KENNETH J HANNAN3 | 5 FRIAR TUCK COURT CLIFTON PARK, NY 12065 | AFLAC | $1 | $0 | $1 | 0.00% |
| DANIELLE ELLIS3 Filed as: DANIELLE M ELLIS | 5949 SISSONVILLE DR CHARLESTON, WV 25312 | AFLAC | $479 | $0 | $479 | 5.32% |
| BRIAN CUMPTAN3 | 320 9TH STREET SUITE 200 HUNTINGTON, WV 25701 | AFLAC | $131 | $0 | $131 | 1.45% |
| CARISSA LYNN MILES3 | PO BOX 156 SAINT ALBANS, WV 25177 | AFLAC | $81 | $0 | $81 | 0.90% |
| DARAN L WYCKOFF3 | 505 N ARGONNE BLDG C SPOKANE VALLEY, WA 99212 | AFLAC | $61 | $0 | $61 | 0.68% |
| SCOTT T JACOB3 | 573 BELLEVUE RD STE B NEWARK, DE 19713 | AFLAC | $27 | $0 | $27 | 0.30% |
| CHARLES A HUTCHINSON3 | 2795 ROBERT C BYRD DR BECKLEY, WV 25801 | AFLAC | $8 | $0 | $8 | 0.09% |
| BRANDON L MILLER3 | 320 9TH ST STE 200 HUNTINGTON, WV 25701 | AFLAC | $8 | $0 | $8 | 0.09% |
| AMANDA R ANDERSON3 | 291 MUDDY CREEK MOUNTAIN RD ALDERSON, WV 24910 | AFLAC | $8 | $0 | $8 | 0.09% |
| FREDERICK W WILSON III3 | 573 BELLEVUE RD NEWARK, DE 19713 | AFLAC | $5 | $0 | $5 | 0.06% |
| MICHAEL C WALKER3 | 203 MARKET ST STE 201 HAVRE DE GRACE, MD 21078 | AFLAC | $3 | $0 | $3 | 0.03% |
| WALTER J CARTER3 | 5587 KANAWHA TPKE SAINT ALBANS, WV 25177 | AFLAC | $1 | $0 | $1 | 0.01% |
| KRISTINE G WYCKOFF3 | PO BOX 952 SPOKANE VALLEY, WA 99037 | AFLAC | $1 | $0 | $1 | 0.01% |
| PAUL B BROUCHOUD3 | 604 MARK DRIVE DEL CITY, OK 73115 | AFLAC | $1 | $0 | $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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 171 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CAPITAL DISRICT PHYSICIAN'S HEALTH PLAN INC | 389 | $1.2M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $110K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 113 | $110K |
| Life insurance(2 contracts) | AFLAC | 28 | $30K |
| Short-term disability(2 contracts) | AFLAC | 28 | $30K |
| Other(2 contracts) | AFLAC | 28 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 389 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.