| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | SUN LIFE AND HEALTH INSURANCE COMPANY | $8K | — | $8K | 7.13% |
| HR BENEFIT ADVISORS3 | 74 BROWNS RACE SUITE 200 ROCHESTER, NY 14614 | SUN LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 1.55% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | SUN LIFE AND HEALTH INSURANCE COMPANY | $3K | — | $3K | 3.11% |
| HR BENEFIT ADVISORS3 | 74 BROWNS RACE SUITE 200 ROCHESTER, NY 14614 | SUN LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 1.87% |
| HR BENEFIT ADVISORS3 | 74 BROWNS RACE SUITE 200 ROCHESTER, NY 14614 | GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 6.31% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | GUARDIAN LIFE INSURANCE COMPANY | $442 | — | $442 | 2.75% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 74 BROWNS RACE STE 200 ROCHESTER, NY 14614 | HARTFORD LIFE INSURANCE O. | $113 | — | $113 | 15.07% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GUARDIAN LIFE INSURANCE COMPANY EIN 13-5123390 CLAIMS PROCESSING | Claims processing Service code 12 | — | $12K |
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 | 249 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INDEPENDENT HEALTH | 61 | $396K |
| Vision | GUARDIAN LIFE INSURANCE COMPANY | 192 | $16K |
| Life insurance | SUN LIFE AND HEALTH INSURANCE COMPANY | 249 | $109K |
| Short-term disability(2 contracts) | SUN LIFE AND HEALTH INSURANCE COMPANY | 256 | $206K |
| Long-term disability | SUN LIFE AND HEALTH INSURANCE COMPANY | 249 | $109K |
| Prescription drug | INDEPENDENT HEALTH | 61 | $396K |
| Other | HARTFORD LIFE INSURANCE O. | 252 | $750 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 256 | — |
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.