| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | EXCELLUS BLUECROSS BLUESHIELD | $63K | — | $63K | 3.89% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | EXCELLUS BLUECROSS BLUESHIELD | $6K | — | $6K | 8.31% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $4K | — | $4K | 6.60% |
| LAURA ANNE CALARCO3 Filed as: LAURA CALARCO | 340 HORSE CREEK DRIVE APT 208 NAPLES, FL 34110 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $1K | $87 | $1K | 7.00% |
| JOSEPH P CALARCO3 Filed as: JOSEPH CALARCO | PO BOX 130 AUBURN, NY 13021 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $374 | $20 | $394 | 2.05% |
| DEBRA PARKER3 | 20 BOWEN STREET AUBURN, NY 13021 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $303 | — | $303 | 1.58% |
| NICHOLAS CALARCO3 | 162 YORK STREET AUBURN, NY 13021 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $273 | — | $273 | 1.42% |
| SUZANNE GOULD3 | 2741 SAND BEACH ROAD AUBURN, NY 13021 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $193 | — | $193 | 1.01% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $61 | — | $61 | 0.32% |
| JOHN B INFERRERA3 Filed as: JOHN INFERRERA | 174 GARNSEY ROAD PITTSFORD, NY 14534 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $51 | — | $51 | 0.27% |
| KIM FLOOD3 | 731 OLD MEDFORD AVE MEDFORD, NY 11763 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $45 | — | $45 | 0.23% |
| TERESA STRONG3 | 1070 SKATES STREET THE VILLAGES, FL 32163 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $43 | — | $43 | 0.22% |
| JEFF DALABA3 | 8500 GILLY FLOWER CT BALDWINSVILLE, NY 13027 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $29 | — | $29 | 0.15% |
| FALCONE ASSOCIATES3 Filed as: FALCONE ASSOCIATES, INC. | 901 LODI STREET SYRACUSE, NY 13203 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $27 | — | $27 | 0.14% |
| BRAD JONES AND ASSOCIATES INC3 Filed as: BRAD JONES AND ASSOCIATES, INC. | 19 BRITISH AMERICAN BLVD LATHAM, NY 12110 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $23 | — | $23 | 0.12% |
| KARL L FONDA3 Filed as: KARL FONDA | 311 BROOKSBORO DR WEBSTER, NY 14580 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $20 | — | $20 | 0.10% |
| CHARLES D. BLOCK3 Filed as: CHARLES GRAY | 105 DAVENTRY LN SUITE 100 LOUISVILLE, KY 40223 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $16 | — | $16 | 0.08% |
| MICHELLE WILLIAMS3 | 12650 55TH ROAD N WEST PALM BEACH, FL 33411 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $15 | — | $15 | 0.08% |
| PATRICK RUHLE3 | 200 GARDEN CITY PLAZA SUITE 410 GARDEN CITY, NY 11530 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $14 | — | $14 | 0.07% |
| KELLY A IRVINE3 Filed as: KELLY IRVINE | 15801 WHITE ORCHID LANE FORT MYERS, FL 33908 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $6 | — | $6 | 0.03% |
| STEVEN DALABA3 | 7683 SEDGEWICK RIDGE ROAD LEWISVILLE, NC 27023 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $5 | — | $5 | 0.03% |
| PAUL THOMAS GIANGRECO3 Filed as: PAUL GIANGRECO | 375 HARRIS HILL ROAD UNIT 232 WILLIAMSVILLE, NY 14221 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $4 | — | $4 | 0.02% |
| LAURIE SMITH3 | 577 TRUESDALE HILL ROAD LAKE GEORGE, NY 12845 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $2 | — | $2 | 0.01% |
| RUSSELL T BARRETT3 Filed as: RUSSELL BARRETT | 27 JULIANS WAY SARATOGA SPRINGS, NY 12866 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $2 | — | $2 | 0.01% |
| KEVIN MURPHY3 | 11 WILLOWBROOK TERRACE CLIFTON PARK, NY 12065 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $2 | — | $2 | 0.01% |
| DAVID B PERLEE3 Filed as: DAVID PERLEE | 1989 NEPTUNE DRIVE ENGLEWOOD, FL 34223 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $1 | — | $1 | 0.01% |
| GREGORY D MAZUROWSKI3 Filed as: GREGORY MAZUROWSKI | 156 DEER RDG GETZVILLE, NY 14068 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $1 | — | $1 | 0.01% |
| MICHAEL P FARLEY3 Filed as: MICHAEL FARLEY | 5586 MAIN STREET SUITE 209 WILLIAMSVILLE, NY 14221 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | $1 | — | $1 | 0.01% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $2K | — | $2K | 15.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $1K | — | $1K | 14.99% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | SHELTERPOINT LIFE INSURANCE COMPANY | $357 | — | $357 | 11.99% |
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 | 196 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 170 | $1.6M |
| Dental | EXCELLUS BLUECROSS BLUESHIELD | 178 | $69K |
| Vision | SHELTERPOINT LIFE INSURANCE COMPANY | 16 | $3K |
| Life insurance | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 148 | $54K |
| Short-term disability | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF NEW YORK | 29 | $19K |
| Long-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 148 | $14K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 170 | $1.6M |
| Other(3 contracts, 2 carriers) | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | 228 | $80K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 228 | — |
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.