| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AFS AGENCY3 | 185 GENESEE STREET STE 210 UTICA, NY 13501 | EXCELLUS | $51K | — | $51K | 2.36% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 NORTH FRANKLIN ST. STE 20 SYRACUSE, NY 13204 | EXCELLUS | $31K | — | $31K | 1.43% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 NORTH FRANKLIN ST. STE 20 SYRACUSE, NY 13201 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $56K | — | $56K | 10.00% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 7.31% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 NORTH FRANKLIN ST. STE 20 SYRACUSE, NY 13204 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 5.19% |
| AFS AGENCY3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | HM LIFE INSURANCE COMPANY OF NEW YORK | $1K | — | $1K | 5.24% |
| CROWN RISK MANAGEMENT, LLC3 Filed as: CROWN RISK MANAGEMENT LLC | 432 NORTH FRANKLIN ST. STE 20 SYRACUSE, NY 13204 | HM LIFE INSURANCE COMPANY OF NEW YORK | $1K | — | $1K | 4.76% |
| ADIRONDACK FINANCIAL SERVICES3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | THE PAUL REVERE LIFE INSURANCE COMPANY | $557 | — | $557 | 4.44% |
| MELISSA PINE3 Filed as: MELISSA BEAUCHEMIN | 334 GRAY STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $248 | $4 | $252 | 2.01% |
| KEVIN EDWARDS3 | 8332 MOYER CARRIAGE CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $175 | $14 | $189 | 1.51% |
| MEAGAN M MARTIN3 | 517 PARK AVENUE SYRACUSE, NY 13204 | THE PAUL REVERE LIFE INSURANCE COMPANY | $92 | — | $92 | 0.73% |
| DONALD H MATSON3 | 8 ROSEWOOD DR AUBURN, NY 13021 | THE PAUL REVERE LIFE INSURANCE COMPANY | $53 | $16 | $69 | 0.55% |
| TRISHA TYMINSKI3 | PO BOX 439 CONSTANTIA, NY 13044 | THE PAUL REVERE LIFE INSURANCE COMPANY | $29 | — | $29 | 0.23% |
| VALERIE CELI3 | 6530 LAKESHORE RD CICERO, NY 13039 | THE PAUL REVERE LIFE INSURANCE COMPANY | $17 | — | $17 | 0.14% |
| ANTHONY MATRONE3 | 4297 ROUTE 31 CLAY, NY 13041 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | — | $4 | 0.03% |
| BRIAN BEAUCHEMIN3 | 334 GRAY STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | — | $4 | 0.03% |
| MCKENZIE ASHLYN PINE3 | 405 WEST STREET HERKIMER, NY 13350 | THE PAUL REVERE LIFE INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| ALISHA K ROBINSON3 Filed as: ALISHA ROBINSON | PO BOX 272 OLD FORGE, NY 13420 | AFLAC | $187 | $19 | $206 | 2.84% |
| JEFFERY S. KOWALSKY3 Filed as: JEFFERY S KOWALSKY | 2530 CHURCH ROAD SAUQUOIT, NY 13456 | AFLAC | $205 | — | $205 | 2.82% |
| JOSEPH P CALARCO3 Filed as: JOSEPH CALARCO | PO BOX 130 AUBURN, NY 13021 | AFLAC | $125 | $4 | $129 | 1.78% |
| DAWN PELLERIN3 | 34 TAMARACK DR NEW HARTFORD, NY 13413 | AFLAC | $87 | — | $87 | 1.20% |
| AFS AGENCY3 | 185 GENESEE ST STE 210 UTICA, NY 13501 | AFLAC | $81 | — | $81 | 1.12% |
| LAURA BOHANNON3 | 23 S MARVINE AVE AUBURN, NY 13021 | AFLAC | $32 | — | $32 | 0.44% |
| EDWARD D YATES JR3 Filed as: EDWARD YATES JR | 2063 COUNTY ROUTE 8 OSWEGO, NY 13126 | AFLAC | $10 | — | $10 | 0.14% |
| KELLY A IRVINE3 Filed as: KELLY IRVINE | 15801 WHITE ORCHID LN FORT MYERS, FL 33908 | AFLAC | $1 | — | $1 | 0.01% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM ST. SYRACUSE, NY 13204 | FIRST UNUM LIFE INSURANCE COMPANY | $16 | — | $16 | 3.86% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS, INC EIN 16-1171765 | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | 115 CONTINUUM DRIVE LIVERPOOL, NY 13088 | $18K |
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0329043 | Claims processing Service code 12 | 165 COURT STREET ROCHESTER, NY 14647 | $10K |
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 | 790 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 799 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS | 244 | $2.2M |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK | 220 | $21K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $43K |
| Short-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 2,523 | $558K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 132 | $30K |
| Prescription drug | EXCELLUS | 244 | $2.2M |
| Other(3 contracts, 3 carriers) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 2,523 | $596K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,523 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.