| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK, INC. | 6 TOWER PLACE ALBANY, NY 12203 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $37K | $5K | $42K | 4.29% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $9K | — | $9K | 0.97% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK, INC. | 6 TOWER PLACE ALBANY, NY 12203 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $3K | — | $3K | 3.64% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $1K | — | $1K | 1.36% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK, INC. | 6 TOWER PLACE ALBANY, NY 12203 | THE GUARDIAN LIFE INSURANCE COMPANY | $2K | $2K | $3K | 14.83% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY | $904 | — | $904 | 3.99% |
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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 186 | $978K |
| Dental(2 contracts, 2 carriers) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 170 | $106K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY | 170 | $23K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY | 170 | $23K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY | 170 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 186 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.