| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NFP INSURANCE SERVICES INC3 Filed as: NFP PROPERTY & CASUALTY SVCS INC | 159 WOLF ROAD SUITE 200 ALBANY, NY 12205 | FIRST UNUM LIFE INSURANCE COMPANY | $15K | $2K | $18K | 2.90% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP PROPERTY & CASUALTY SVCS INC | 159 WOLF ROAD SUITE 200 ALBANY, NY 12205 | FIRST UNUM LIFE INSURANCE COMPANY | $6K | $886 | $7K | 2.43% |
| JEFFREY GREENBLOTT3 | 4232 EMERSON PL VESTAL, NY 13850 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4K | — | $4K | 7.29% |
| ROSE & KIERNAN INC3 | PO BOX 640 EAST GREENBUSH, NY 12061 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 5.87% |
| BERT VAN DER WERFF3 | PO BOX 43 ANNSVILLE, NY 13308 | THE PAUL REVERE LIFE INSURANCE COMPANY | $509 | $46 | $555 | 0.94% |
| FOUR POINTS INC3 | 8049 BARONY WOODS PITTSFORD, NY 14534 | THE PAUL REVERE LIFE INSURANCE COMPANY | $80 | — | $80 | 0.14% |
| NFP INSURANCE SERVICES INC3 Filed as: NFP PROPERTY & CASUALTY SVCS INC | 159 WOLF ROAD SUITE 200 ALBANY, NY 12205 | UNUM LIFE INSURANCE COMPANY | $2K | -$219 | $2K | 3.50% |
| MULTIPLE BROKERS (SEE APPENDIX)3 Filed as: MULTIPLE BROKERS SEE APPENDIX | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $5K | — | $5K | 12.13% |
| JEFFREY GREENBLOTT3 | 4232 EMERSON PL VESTAL, NY 13308 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $369 | — | $369 | 4.08% |
| ROSE & KIERNAN INC3 | PO BOX 640 EAST GREENBUSH, NY 12061 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $344 | — | $344 | 3.80% |
| BERT VAN DER WERFF3 | PO BOX 43 ANNSVILLE, NY 13308 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $214 | $238 | 2.63% |
| MULTIPLE BROKERS (SEE APPENDIX)3 Filed as: MULTIPLE BROKERS SEE APPENDIX | 1932 WYNNTON ROAD COLUMBUS, GA 31999 | AFLAC | $859 | — | $859 | 9.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 MEDICAL ASO FEES | Claims processing Service code 12 | — | $532K |
| EMPLOYEE NETWORK, INC. EIN 16-1285790 EAP FEES | Claims processing; Contract Administrator Service code 12 | — | $21K |
| ROSE & KIERNAN, INC. MEDICAL/ RX COMMISSIONS | Other commissions Service code 55 | 159 WOLF ROAD ALBANY, NY 12205 | $12K |
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 | 830 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 27 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 857 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NEW YORK | 684 | $465K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 572 | $62K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 830 | $604K |
| Short-term disability(2 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 830 | $654K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 830 | $604K |
| Other(5 contracts, 4 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 648 | $418K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 830 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.