| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | 99 TROY ROAD ESAT GREENBUSH, NY 12061 | EXCELLUS BLUECROSS BLUESHIELD | $24K | — | $24K | 10.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK STE 400 FAIRPORT, NY 14450 | AFLAC | $5K | — | $5K | 16.74% |
| DANIEL WILEY3 | 22113 FABCO ROAD WATERTOWN, NY 13601 | AFLAC | $938 | — | $938 | 2.89% |
| DEBRA PARKER3 | 20 BOWEN STREET AUBURN, NY 13021 | AFLAC | $420 | — | $420 | 1.30% |
| DAWN PELLERIN3 Filed as: DAWN PELLERN | 34 TAMARACK DRIVE NEW HARTFORD, NY 13413 | AFLAC | $132 | $43 | $175 | 0.54% |
| JEFF DALABA3 | 8500 GILLY FLOWER COURT BALDWINSVILLE, NM 13027 | AFLAC | $108 | — | $108 | 0.33% |
| DAVID A COLLISON3 | 46 JOHNSTONE LANE GEORGETOWN, SC 29440 | AFLAC | $104 | — | $104 | 0.32% |
| ANDREW THOMAS3 | 101 OLD COVE ROAD STE 114 LIVERPOOL, NY 13090 | AFLAC | $47 | — | $47 | 0.14% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | 99 TROY ROAD EAST GREENBUSH, NY 12061 | DELTA DENTAL | $4K | — | $4K | — |
| HANYS BENEFIT SERVICES3 | — | DELTA DENTAL | $957 | — | $957 | — |
| THE FARMINGTON COMPANY3 Filed as: FARMINGTON COMPANY | 30 WATERSIDE DRIVE FARMINGTON, CT 06034 | AFLAC | $45 | — | $45 | — |
| RONALD V. SANTINO3 Filed as: RONALD SANTINO | 141 EASTWOOD AVE UTICA, NY 13501 | AFLAC | $37 | — | $37 | — |
| MARY FRANCES CARLTON3 Filed as: MARY CARLTON | 3824 HOGAN RD VERNON CENTER, NY 13477 | AFLAC | $31 | — | $31 | — |
| BRIA MCLAUCHLAN3 | 303 FOREST DRIVE NORTH SYRACUSE, NY 13212 | AFLAC | $31 | — | $31 | — |
| GIBIDES INC3 | 1901 CRAG BURN LANE RALEIGH, NC 27604 | AFLAC | $28 | — | $28 | — |
| DAVID M COUGHLIN3 | 3681 STARBRIGHT LANE LAS VEGAS, NV 89147 | AFLAC | $28 | — | $28 | — |
| BRAD JONES AND ASSOCIATES INC3 Filed as: BRAD JONES & ASSOCIATES | 19 BRITISH AMERICAN BLVD LATHAM, NY 12110 | AFLAC | $27 | — | $27 | — |
| DAVID WEINGARTNER3 | 15 DAVID DRIVE JOHNSON CITY, NY 13790 | AFLAC | $26 | — | $26 | — |
| JENNIE E RUSSO3 Filed as: JENNIE RUSSO | 4802 BURRSTONE ROAD SYRACUSE, NM 13215 | AFLAC | $18 | — | $18 | — |
| FALCONE ASSOCIATES3 Filed as: FALCONE ASSOCIATES, INC | 901 LODI STREET SYRACUSE, NY 13203 | AFLAC | $12 | — | $12 | — |
| THE WLADIS GEORGE L COMPANY INC3 Filed as: THE WLADIS GEORGE L COMPANY | 526 PLUM COURT #250 SYRACUSE, NY 13204 | AFLAC | $11 | — | $11 | — |
| JOSEPH P CALARCO3 Filed as: JOSEPH CALARCO | 13 ARTERIAL EAST PO BOX 130 AUBURN, NM 13021 | AFLAC | $11 | — | $11 | — |
| LOUIS R FAIOLA3 | 12 HAAWK CT DELMAR, NM 12054 | AFLAC | $3 | — | $3 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 TPA | Claims processing Service code 12 | — | $282K |
| DELTA DENTAL EIN 11-1980218 TPA | Claims processing Service code 12 | — | $29K |
| EXPRESS SCRIPTS EIN 45-2884094 TPA | Claims processing Service code 12 | — | $22K |
| KEENAN RX COALITION | Other fees Service code 99 | PO BOX 4328 TORRANCE, CA 90510 | $17K |
| BRIDGES EAP | Other fees Service code 99 | 112 FARRIER AVENUE SUITE 314 ONEIDA, NM 13421 | $14K |
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 | 525 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 537 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 537 | $76K |
| Dental | DELTA DENTAL | 537 | $0 |
| Prescription drug | EXPRESS SCRIPTS | 537 | $0 |
| Stop-loss / reinsurancereinsurance | EXCELLUS BLUECROSS BLUESHIELD | 537 | $243K |
| Other(3 contracts) | AFLAC | 78 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 537 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.