| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFS AGENCY3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | EXCELLUS BLUECROSS BLUESHIELD | $66K | — | $66K | 3.20% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET UTICA, NY 13501 | THE HARTFORD | $6K | — | $6K | 2.18% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET FLOOR 2 UTICA, NY 13501 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | — | $4K | 10.49% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | — | $3K | 13.61% |
| MEAGAN M MARTIN3 | 721 NORTH CLINTON STREET SYRACUSE, NY 13204 | THE PAUL REVERE LIFE INSURANCE COMPANY | $944 | $2K | $2K | 11.77% |
| KEVIN EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $980 | $1K | $2K | 10.48% |
| VALERIE CELI3 | 6530 LAKEHORE ROAD CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $985 | $984 | $2K | 9.30% |
| RYAN DORSEY3 | 4483 MILLSTREAM DRIVE CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $774 | $772 | $2K | 7.30% |
| LUCIA DORSEY3 | 4483 MILLSTREAM DRIVE CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $872 | — | $872 | 4.12% |
| TRISHA TYMINSKI3 | PO BOX 439 CONSTANTIA, NY 13044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $557 | $239 | $796 | 3.76% |
| ANTHONY MATRONE3 | 4797 ROUTE 31 CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $103 | $57 | $160 | 0.76% |
| CHRISTINE MARIE EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $41 | — | $41 | 0.19% |
| JEFFERY S. KOWALSKY3 Filed as: JEFFERY KOWALSKY | 2530 CHURCH ROAD SAUQUOIT, NY 13456 | AFLAC | $2K | $74 | $2K | 11.93% |
| MICHAEL DAMSKY3 | 2113 GENESEE STREET UTICA, NY 13501 | AFLAC | $490 | — | $490 | 3.66% |
| DAWN PELLERIN3 | 34 TAMARACK DRIVE NEW HARTFORD, NY 13413 | AFLAC | $425 | $15 | $440 | 3.28% |
| JOSEPH P CALARCO3 Filed as: JOSEPH CALARICO | 13 ARTERIAL EAST PO BOX 130 AUBURN, NY 13021 | AFLAC | $395 | $24 | $419 | 3.13% |
| EDWARD D YATES JR3 Filed as: EDWARD YATES JR | 2063 COUNTY ROUTE 8 OSWEGO, NY 13126 | AFLAC | $93 | $4 | $97 | 0.72% |
| STEVEN E DALABA3 Filed as: STEVEN DALADA | 1215 PEBBLE MEADOWS DRIVE LEWISVILLE, NC 27023 | AFLAC | $27 | — | $27 | 0.20% |
| BRAD JONES AND ASSOCIATES INC3 | 19 BRITISH AMERICAN BLVD LATHAM, NY 12110 | AFLAC | $24 | — | $24 | 0.18% |
| WILLIAM S MATHIAS3 Filed as: WILLIAM MATHIAS | PO BOX 83 NEW HARTFORD, NY 13413 | AFLAC | $23 | — | $23 | 0.17% |
| LAURA BOHANNON3 | 23 S MARVINE AVE AUBURN, NY 13021 | AFLAC | $19 | $1 | $20 | 0.15% |
| STEPHEN CONNORS3 | 108 HUNTSHILL ROAD SYRACUSE, NY 13209 | AFLAC | $17 | — | $17 | 0.13% |
| GIBIDES INC3 | 1901 CRAG BURN LANE RALEIGH, NC 27604 | AFLAC | $17 | — | $17 | 0.13% |
| JEFF DALABA3 | 6500 GILLY FLOWER COURT BALDWINSVILLE, NY 13027 | AFLAC | $5 | — | $5 | 0.04% |
| KELLY A IRVINE3 Filed as: KELLY IRVINE | 333 GLEN STREET SUITE 201 GLENS FALLS, NY 12801 | AFLAC | $3 | $1 | $4 | 0.03% |
| KEVIN MURPHY3 | 11 WILLOWBROOK TERRACE CLIFTON PARK, NY 12085 | AFLAC | $1 | — | $1 | 0.01% |
| DUCK & COVER NY INC3 | 17 DALAMAR CT LATHAM, NY 12110 | AFLAC | $1 | — | $1 | 0.01% |
| AFS AGENCY3 | 185 GENESEE STREET SUITE 210 UTICA, NY 13501 | HM LIFE INSURANCE COMPANY OF NEW YORK | $1K | — | $1K | 10.00% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | BROWN BROWN OF NEW YORK INC ROME, NY 13441 | FIRST UNUM LIFE INSURANCE COMPANY | $12 | — | $12 | 2.89% |
| AFS AGENCY3 | 185 GENESEE STREET SUITE 210 UTICA, NY 13501 | HM LIFE INSURANCE COMPANY OF NEW YORK | $7 | — | $7 | 9.59% |
| ANTHONY MATRONE3 | 4797 ROUTE 31 CLAY, NY 13041 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| CHRISTINE MARIE EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| VALERIE CELI3 | 6530 LAKEHORE ROAD CICERO, NY 13039 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| TRISHA TYMINSKI3 | PO BOX 439 CONSTANTIA, NY 13044 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| KEVIN EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| RYAN DORSEY3 | 4483 MILLSTREAM DRIVE CLAY, NY 13041 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | LIFETIME BENEFIT SOLUTIONS | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS, INC EIN 16-1171765 | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | 115 CONTINUUM DRIVE LIVERPOOL, NY 13088 | $8K |
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 | 832 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 843 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 271 | $2.1M |
| Vision(3 contracts, 2 carriers) | HM LIFE INSURANCE COMPANY OF NEW YORK | 154 | $13K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 200 | $59K |
| Short-term disability | THE HARTFORD | 2,432 | $264K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 200 | $38K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 271 | $2.1M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 200 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,432 | — |
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.