| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LAWLEY BENEFITS GROUP LLC3 | 361 DELAWARE AVENUE BUFFALO, NY 14202 | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | $43K | — | $43K | 2.68% |
| LAWLEY BENEFITS GROUP LLC3 | 361 DELAWARE AVENUE BUFFALO, NY 14202 | GUARDIAN | $17K | $11K | $28K | 10.45% |
| LAWLEY BENEFITS GROUP LLC3 | 361 DELAWARE AVENUE BUFFALO, NY 14202 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 11.79% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | THE PAUL REVERE LIFE INSURANCE COMPANY | $641 | $26 | $667 | 7.73% |
| STEPHEN JOSEPH JOYCE3 | 70 SARGENT DR AMHERST, NY 14226 | THE PAUL REVERE LIFE INSURANCE COMPANY | $429 | $71 | $500 | 5.79% |
| DAVID J ROBERTS3 | 167 NEVINS ROAD HENRIETTA, NY 14467 | THE PAUL REVERE LIFE INSURANCE COMPANY | $110 | $0 | $110 | 1.27% |
| FRANK DAMBROSIO3 | 23 LONGVIEW DRIVE MAHOPAC, NY 10541 | THE PAUL REVERE LIFE INSURANCE COMPANY | $25 | $3 | $28 | 0.32% |
| ALAN JUSTIN3 | 5165 BROADWAY DEPEW, NY 14043 | THE PAUL REVERE LIFE INSURANCE COMPANY | $22 | $0 | $22 | 0.25% |
| KARL L FONDA3 | 311 BROOKSBORO DR WEBSTER, NY 14580 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.05% |
| ROBERT W SABOL3 | 24 STEVENSON AVE CORTLANDT MNR, NY 10567 | THE PAUL REVERE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.05% |
| TARINA JAN BAKER3 | 14723 BEACON HILL CT MIDLOTHIAN, VA 23112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | $1 | $104 | 10.21% |
| AMY E COHEN3 Filed as: AMY SELAK | 6901 WALMORE ROAD NIAGARA FALLS, NY 14304 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $35 | $19 | $54 | 5.30% |
| REBECCA J MERRITT3 | 927 EAST KEIM DR PHOENIX, AZ 85014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $25 | $3 | $28 | 2.75% |
| STEPHEN JOSEPH JOYCE3 | 70 SARGENT DR AMHERST, NY 14226 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $20 | $4 | $24 | 2.36% |
| JW BENEFIT SOLUTIONS INC3 | 3117 STONE ARBOR LN GLEN ALLEN, VA 23059 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | $0 | $8 | 0.79% |
| MARQUEZ BENEFIT GROUP LLC3 | 8611 N BLACK CANYON HWY PHOENIX, AZ 85021 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | $3 | $7 | 0.69% |
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 | 266 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 459 | $1.6M |
| Dental | GUARDIAN | 266 | $271K |
| Vision | GUARDIAN | 266 | $271K |
| Life insurance | GUARDIAN | 266 | $271K |
| Short-term disability | GUARDIAN | 266 | $271K |
| Long-term disability | GUARDIAN | 266 | $271K |
| Prescription drug(2 contracts) | BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 459 | $1.6M |
| Other(3 contracts, 3 carriers) | GUARDIAN | 266 | $281K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 459 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.