| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SECURE SOLUTION ASSOCIATES LLC3 | 351 RIVERVIEW ROAD KING OF PRUSSIA, PA 19406 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4K | — | $4K | 3.55% |
| CBNA INSURANCE AGENCY INC3 | P.O. BOX 747 TUPPER LAKE, NY 12986 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2K | — | $2K | 1.61% |
| NICK DELIA3 | 105 BREWSTER DRIVE NEWARK, DE 19711 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2K | — | $2K | 1.54% |
| DONALD H MATSON3 Filed as: DONALD H. MASTON | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $315 | $75 | $390 | 0.36% |
| STEVEN C ELLIOTT3 Filed as: STEVEN C ELLIOT | 800 STARBUCK AVE WATERTOWN, NY 13601 | THE PAUL REVERE LIFE INSURANCE COMPANY | $121 | — | $121 | 0.11% |
| SECURE SOLUTION ASSOCIATES LLC3 | 351 RIVERVIEW RD KING OF PRUSSIA, PA 19406 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $515 | — | $515 | 2.99% |
| NICK DELIA3 | 105 BREWSTER DRIVE NEWARK, DE 19711 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $286 | — | $286 | 1.66% |
| CBNA INSURANCE AGENCY INC3 | P.O. BOX 747 TUPPER LAKE, NY 12986 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $270 | — | $270 | 1.57% |
| JEFFREY GREENBLOTT3 | 4232 EMERSON PLACE VESTAL, NY 13850 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.28% |
| DONALD H MATSON3 Filed as: DONALD H MASTON | 8 ROSEWOOD DRIVE AUBURN, NY 13021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $34 | $1 | $35 | 0.20% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF NY INC | 500 PLUM STREET SUITE 200 SYRACUSE, NY 13204 | HARTFORD LIFE INSURANCE COMPANY | $335 | — | $335 | 15.02% |
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 | 2,487 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 373 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,860 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 3,546 | $604K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 402 | $51K |
| Other(4 contracts, 4 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 3,546 | $732K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,546 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.