| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | MVP HEALTHCARE | $45K | — | $45K | 4.35% |
| TIMOTHY J CLAIN3 | PO BOX 906 RUTLAND, VT 05702 | FIRST UNUM LIFE INSURANCE COMPANY | $15K | — | $15K | 2.67% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 800 PARKER HILL DRIVE STE 100 ROCHESTER, NY 14625 | DELTA DENTAL OF NEW YORK | $7K | — | $7K | 1.56% |
| TIMOTHY J CLAIN3 | PO BOX 906 RUTLAND, VT 05702 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $2K | — | $2K | 10.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MERITAIN HEALTH EIN 16-1264154 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $373K |
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 | 902 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 902 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MVP HEALTHCARE | 76 | $1.0M |
| Dental | DELTA DENTAL OF NEW YORK | 1,125 | $459K |
| Vision | ANTHEM BLUE CROSS (G1921) | 127 | $5K |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 902 | $543K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 902 | $543K |
| Other(2 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 902 | $565K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,125 | — |
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."
No prospect flags tripped on this filing.