| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEITH MACTAVISH3 Filed as: KEITH R MACTAVISH | PO BOX 14105 ALBANY, NY 12212 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $130K | $0 | $130K | 2.58% |
| KLEEBER AGENCY INC3 Filed as: THE KLEEBER AGENCY, INC. | 2880 ROUTE 9 P.O. BOX 794 VALATIE, NY 12184 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $24K | $0 | $24K | 0.48% |
| KEITH MACTAVISH3 | 33 COUNTRY ROUTE 401 GREENVILLE, NY 120832100 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 3.89% |
| KLEEBER AGENCY INC3 Filed as: THE KLEEBER AGENCY INC | 2880 US HIGHWAY 9 PO BOX 794 VALATIE, NY 121845423 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.16% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: REUBEN WARNER ASSOCIATES | 2880 ROUTE 9 VALATIE, NY 12184 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $0 | $3K | $3K | 5.00% |
| KLEEBER AGENCY INC3 | 2880 ROUTE 9 VALATIE, NY 12184 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $3K | $0 | $3K | 4.78% |
| KEITH MACTAVISH3 | 33 COUNTRY ROUTE 401 GREENVILLE, NY 12083 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $2K | $0 | $2K | 3.04% |
| A&B AGENCY3 | PO BOX 14105 ALBANY, NY 12212 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $111 | $0 | $111 | 0.19% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: REUBEN WARNER ASSOCIATES | 1655 RICHMOND AVENUE STATEN ISLAND, NY 10314 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $0 | $2K | $2K | 5.00% |
| KLEEBER AGENCY INC3 | 2880 ROUTE 9 VALATIE, NY 12184 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $1K | $0 | $1K | 3.66% |
| KEITH MACTAVISH3 | 33 COUNTRY ROUTE 401 GREENVILLE, NY 12083 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $1K | $0 | $1K | 3.58% |
| A&B AGENCY3 | PO BOX 14105 ALBANY, NY 12212 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $163 | $0 | $163 | 0.46% |
| KEITH MACTAVISH3 | 33 COUNTRY ROUTE 401 GREENVILLE, NY 12083 | DELTA DENTAL OF NEW YORK | $12K | $0 | $12K | 66.70% |
| KLEEBER AGENCY INC3 Filed as: THE KLEEBER AGENCY | 2880 ROUTE 9 PO BOX 794 VALATIE, NY 12184 | DELTA DENTAL OF NEW YORK | $6K | $0 | $6K | 33.30% |
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 | 426 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 426 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 435 | $5.0M |
| Dental | DELTA DENTAL OF NEW YORK | 461 | $18K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 405 | $64K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 574 | $122K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 587 | $58K |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 618 | $158K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 618 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.