| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PROFESSIONAL GROUP PLANS INC Filed as: PROFESSIONAL GROUP PLANS | 225 WIRELESS BLVD SUITE 200 HAUPPAUGE, NY 11788 | GUARDIAN | $10K | $4K | $14K | 13.74% |
| DOMINICK R SIRACUSA | 225 DOLSON AVE SUITE 304 MIDDLETOWN, NY 10940 | AFLAC | $2K | $56 | $3K | 65.80% |
| JEAN-MARC ARCHER | 2 WOODLAND AVE MIDDLETOWN, NY 10940 | AFLAC | $2K | — | $2K | 40.02% |
| LARRY JAY BLUM | PO BOX 254 TALLMAN, NY 10982 | AFLAC | $980 | — | $980 | 25.55% |
| JASON SCZEPANIAK Filed as: JASON HARTMAN | 560 WHITE PLAINS RD SUITE 320 TARRYTOWN, NY 10591 | AFLAC | $603 | $16 | $619 | 16.14% |
| JASON SCZEPANIAK Filed as: JASON HARTMAN | 560 WHITE PLAINS RD SUITE 320 TARRYTOWN, NY 10591 | AFLAC | $603 | — | $603 | 15.72% |
| ROBERT G. RELPH AGENCY, INC. Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | AFLAC | $540 | — | $540 | 14.08% |
| GRACE IENUSO | 96 MYERS RD NEVERSINK, NY 12765 | AFLAC | $471 | — | $471 | 12.28% |
| DAVID YEGELWELL | 8 MCNALLY ST GOSHEN, NY 10924 | AFLAC | $291 | $23 | $314 | 8.19% |
| JENNIFER LINGLE | 220 PARK LANE WARWICK, NY 10990 | AFLAC | $183 | — | $183 | 4.77% |
| MCINERNEY GROUP LLC | 580 WHITE PLAINS ROAD SUITE 600 TARRYTOWN, NY 10591 | AFLAC | $165 | — | $165 | 4.30% |
| W E BRENNAN INC | 5 CORPORATE DRIVE SUITE 104 CENTRAL VALLEY, NY 10917 | AFLAC | $136 | — | $136 | 3.55% |
| JEFF DALABA | 8500 GILLY FLOWER COURT BALDWINSVILLE, NY 13027 | AFLAC | $51 | — | $51 | 1.33% |
| DEBRA PARKER | 20 BOWEN STREET AUBURN, NY 13021 | AFLAC | $46 | — | $46 | 1.20% |
| AMERICAN TEL-TEK INC. Filed as: AMERICAN TEL-TEK INC | C/O ESTELLE TOLSON 92 NORTH AVENUE SUITE 204 NEW ROCHELLE, NY 10801 | AFLAC | $21 | — | $21 | 0.55% |
| WALTER TOLSON | 316 S OCEAN DR APT 2 FORT PIERCE, FL 34949 | AFLAC | $20 | — | $20 | 0.52% |
| HUGO D GRAJEDA | 25 WHITETAIL RUN RD CHESTER, NY 10918 | AFLAC | $12 | — | $12 | 0.31% |
| NANCY A PODHRADSKY | 71 DARLING AVE NEW ROCHELLE, NY 10804 | AFLAC | $11 | — | $11 | 0.29% |
| GREGORY MEYER | 1741 TREDEGAR RD KERNERSVILLE, NC 27284 | AFLAC | $11 | — | $11 | 0.29% |
| KENNETH C MEIER CORP | 401 FRANKLIN AVENUE SUITE 312 GARDEN CITY, NY 11530 | AFLAC | $4 | — | $4 | 0.10% |
| RANDI E RIVA | 312 GALLERY LN MOUNT BETHEL, PA 18343 | AFLAC | — | — | $0 | 0.00% |
| ROBERT G. RELPH AGENCY, INC. Filed as: ROBERT G RELPH AGENCY INC | 1150 G PITTSFORD VICTOR ROAD 2ND FLOOR PITTSFORD, NY 14534 | AFLAC | — | — | $0 | 0.00% |
| STEPHEN PIKUL | 81 LOWER RESERVOIR ROAD GOSHEN, NY 10924 | AFLAC | — | — | $0 | 0.00% |
| CLIFF NIER | 225 DOLSON AVE 3RD FLOOR MIDDLETOWN, NY 10940 | AFLAC | — | — | $0 | 0.00% |
| RANDI E RIVA Filed as: RANDI RIVA | 41 BAYBERRY LANE MIDDLETOWN, NJ 07748 | AFLAC | — | — | $0 | 0.00% |
| ANNE MARIE BEEKMAN | 22 VOSHAGE RD PINE BUSH, NY 12566 | AFLAC | — | — | $0 | 0.00% |
| CLIFF NIER | 99 RT 17A GOSHEN, NY 10924 | AFLAC | — | — | $0 | 0.00% |
| WALTER TOLSON | 30 HARDING RD GORHAM, ME 04038 | AFLAC | — | — | $0 | 0.00% |
| DEBRA PARKER | 1000 PITTSFORD-VICTOR RD PITTSFORD, NY 14534 | AFLAC | — | — | $0 | 0.00% |
| GREGORY E MEYER | 8875 HIDDEN RIVER PARKWAY #300 TAMPA, FL 33637 | AFLAC | — | — | $0 | 0.00% |
| ROBERT G. RELPH AGENCY, INC. Filed as: ROBERT G RELPH AGENCY | 22113 FABCO RD WATERTOWN, NY 13601 | FIRST UNUM LIFE INSURANCE COMPANY | $366 | — | $366 | 10.86% |
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 | 199 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AFLAC | 49 | $4K |
| Dental(2 contracts, 2 carriers) | GUARDIAN | 199 | $102K |
| Vision(2 contracts, 2 carriers) | GUARDIAN | 199 | $102K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 8 | $3K |
| Other(2 contracts, 2 carriers) | GUARDIAN | 199 | $102K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.