| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFS AGENCY3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | EXCELLUS BLUECROSS BLUESHIELD | $72K | — | $72K | 3.69% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | THE HARTFORD | $7K | $2K | $9K | 4.26% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $2K | — | $2K | 14.63% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $1K | — | $1K | 11.22% |
| RYAN DORSEY3 | 4483 MILLSTREAM DRIVE CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2K | $4K | $5K | 42.45% |
| KEVIN EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $1K | $3K | 21.00% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 20.13% |
| TRISHA TYMINSKI3 | PO BOX 439 CONSTANTIA, NY 13044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $154 | $2K | 12.26% |
| ANTHONY MATRONE3 | 4797 ROUTE 31 CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $240 | $524 | $764 | 6.10% |
| VALERIE CELI3 | 6530 LAKEHORE ROAD CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $262 | $406 | $668 | 5.34% |
| CHRISTINE MARIE EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $284 | $8 | $292 | 2.33% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | LIFETIME BENEFIT SOLUTIONS | $1K | — | $1K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NY INC | PO BOX 231 ROME, NY 13442 | FIRST UNUM LIFE INSURANCE COMPANY | $34 | — | $34 | 7.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS, INC EIN 16-1171765 | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 115 CONTINUUM DRIVE LIVERPOOL, NY 13088 | $7K |
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 | 636 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 641 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 289 | $2.0M |
| Vision | LIFETIME BENEFIT SOLUTIONS | 150 | $11K |
| Life insurance(3 contracts, 3 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 228 | $26K |
| Short-term disability | THE HARTFORD | 2,274 | $218K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 228 | $16K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 289 | $2.0M |
| Other | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 228 | $13K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,274 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.