| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFS AGENCY3 | 185 GENESEE STREET, 2ND FLOOR UTICA, NY 13501 | MVP HEALTH CARE | $102K | $0 | $102K | 3.58% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 N FRANKLIN ST SYRACUSE, NY 13204 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $21K | $0 | $21K | 10.00% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 N FRANKLIN ST SYRACUSE, NY 13204 | THE HARTFORD | $2K | $0 | $2K | 1.20% |
| AFS AGENCY3 | 185 GENESEE STREET UTICA, NY 13501 | THE HARTFORD | $815 | $0 | $815 | 0.46% |
| AFS AGENCY3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 12.90% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.68% |
| TRISHA TYMINSKI3 | PO BOX 439 CONSTANTIA, NY 13044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $648 | $11 | $659 | 2.99% |
| KEVIN EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $272 | $260 | $532 | 2.42% |
| MELISSA PINE3 | 708 PARK AVE HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $287 | $149 | $436 | 1.98% |
| MEAGAN M MARTIN3 | 721 NORTH CLINTON STREET SYRACUSE, NY 13204 | THE PAUL REVERE LIFE INSURANCE COMPANY | $120 | $77 | $197 | 0.89% |
| VALERIE CELI3 | 6530 LAKESHORE RD CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $108 | $36 | $144 | 0.65% |
| ANTHONY MATRONE3 | 4797 ROUTE 31 CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $8 | $0 | $8 | 0.04% |
| AFS AGENCY3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | HM LIFE INSURANCE COMPANY OF NEW YORK | $2K | $0 | $2K | 10.00% |
| JEFFERY S. KOWALSKY3 Filed as: JEFFERY S KOWALSKY | 2530 CHURCH ROAD SAUQUOIT, NY 13456 | AFLAC | $1K | $36 | $1K | 9.76% |
| MICHAEL DAMSKY3 | 2113 GENESEE ST UTICA, NY 13501 | AFLAC | $395 | $0 | $395 | 2.96% |
| JOSEPH P CALARCO3 Filed as: JOSEPH CALARCO | PO BOX 130 63 GENESEE ST STE 2 AUBURN, NY 13021 | AFLAC | $347 | $10 | $357 | 2.68% |
| DAWN PELLERIN3 | 34 TAMARACK DR NEW HARTFORD, NY 13413 | AFLAC | $333 | $7 | $340 | 2.55% |
| LAURA BOHANNON3 | 23 S MARVINE AVE AUBURN, NY 13021 | AFLAC | $110 | $3 | $113 | 0.85% |
| CESACO LLC3 | 1619 43RD ST BROOKLYN, NY 11204 | AFLAC | $95 | $0 | $95 | 0.71% |
| ALISHA K ROBINSON3 Filed as: ALISHA ROBINSON | PO BOX 272 OLD FORGE, NY 13420 | AFLAC | $62 | $0 | $62 | 0.47% |
| ALBERT BRUCKNER3 | 3018 BROADWAY APT 2E ASTORIA, NY 11106 | AFLAC | $40 | $17 | $57 | 0.43% |
| JAMES REYNOLDS3 | 10 GROVE AVE NORWICH, NY 13815 | AFLAC | $27 | $0 | $27 | 0.20% |
| EDWARD D YATES JR3 Filed as: EDWARD YATES JR | 2063 COUNTY ROUTE 8 OSWEGO, NY 13126 | AFLAC | $25 | $0 | $25 | 0.19% |
| WILLIAM S MATHIAS3 Filed as: WILLIAM MATHIAS | PO BOX 83 NEW HARTFORD, NY 13413 | AFLAC | $12 | $0 | $12 | 0.09% |
| MARY FRANCES CARLTON3 Filed as: MARY CARLTON | 3824 HOGAN RD VERNON CENTER, NY 13477 | AFLAC | $12 | $0 | $12 | 0.09% |
| BRAD JONES AND ASSOCIATES INC3 Filed as: BRAD JONES AND ASSOCIATES | 19 BRITISH AMERICAN BLVD LATHAM, NY 12110 | AFLAC | $12 | $0 | $12 | 0.09% |
| STEVEN DALABA3 | 7683 SEDGEWICK RIDGE RD LEWISVILLE, NC 27023 | AFLAC | $10 | $0 | $10 | 0.08% |
| CHANI ADOLF3 | 1619 43RD ST BROOKLYN, NY 11204 | AFLAC | $4 | $6 | $10 | 0.08% |
| JACQUES P DAVID CORPORATION3 | 125 JERICHO TPKE STE 201 JERICHO, NY 11753 | AFLAC | $4 | $6 | $10 | 0.08% |
| STEPHEN CONNORS3 | 108 HUNTSHILL RD SYRACUSE, NY 13209 | AFLAC | $8 | $0 | $8 | 0.06% |
| KELLY A IRVINE3 Filed as: KELLY IRVINE | 20620 EAST GOLDEN ELM DR ESTERO, FL 33928 | AFLAC | $7 | $0 | $7 | 0.05% |
| RICHARD G SHEERAN3 | 460 N FRANKLIN ST APT 402 SYRACUSE, NY 13204 | AFLAC | $7 | $0 | $7 | 0.05% |
| SHAWN DECELLE3 | 20 WILLOW LN WYANTSKILL, NY 12198 | AFLAC | $7 | $0 | $7 | 0.05% |
| JEFF DALABA3 | 8500 GILLY FLOWER CT BALDWINSVILLE, NY 13027 | AFLAC | $6 | $0 | $6 | 0.05% |
| AMY PETERS3 | 20 WILLOW LN WYANTSKILL, NY 12198 | AFLAC | $5 | $0 | $5 | 0.04% |
| DUCK & COVER NY INC3 | 17 DALAMAR CT LATHAM, NY 12110 | AFLAC | $3 | $0 | $3 | 0.02% |
| RACHAEL HICKOK3 | 63 ACADEMY ST GREENWICH, NY 12834 | AFLAC | $3 | $0 | $3 | 0.02% |
| MELISSA STEWART3 | 36 WINCOMA LN QUEENSBURY, NY 12804 | AFLAC | $2 | $0 | $2 | 0.02% |
| KEVIN MURPHY3 | 11 WILLOWBROOK TER CLIFTON PARK, NY 12065 | AFLAC | $2 | $0 | $2 | 0.02% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 117 W LIBERTY ST STE 2 ROME, NY 13441 | FIRST UNUM LIFE INSURANCE COMPANY | $16 | $0 | $16 | 3.86% |
| 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 | $13K |
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 | 1,061 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,065 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MVP HEALTH CARE | 413 | $2.9M |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK | 285 | $21K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $59K |
| Short-term disability(2 contracts, 2 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 3,457 | $393K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 215 | $36K |
| Prescription drug | MVP HEALTH CARE | 413 | $2.9M |
| Other(3 contracts, 3 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 3,457 | $265K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,457 | — |
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.