| 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 | HIGHMARK NORTHEASTERN NEW YORK | $48K | — | $48K | 3.71% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $4K | — | $4K | 4.86% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $3K | — | $3K | 12.71% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY | $6K | — | $6K | 24.35% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC | 99 TROY ROAD 3RD FLOOR EAST GREENBUSH, NY 12061 | TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY | $449 | — | $449 | 1.69% |
| EMPLOYEE FAMILY PROTECTION INC3 Filed as: EMPLOYEE FAMILY PROTECTION, INC. | PO BOX 1237 GLASTONBURY, CT 06033 | TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY | $304 | — | $304 | 1.15% |
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 | 260 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 260 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HIGHMARK NORTHEASTERN NEW YORK | 181 | $1.3M |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 207 | $88K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 207 | $88K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 260 | $54K |
| Short-term disability | TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY | 159 | $26K |
| Long-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 260 | $27K |
| Other(2 contracts, 2 carriers) | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 260 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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.