| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.5 Filed as: ROBERT G RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | EXCELLUS BLUECROSS BLUESHIELD | $84K | — | $84K | 3.04% |
| EBPA, LLC5 | PO BOX 2365 SOUTH BURLINGTON, VT 054072365 | EBPA, LLC | — | $13K | $13K | — |
| NORTHERN INSURING AGENCY INC.3 Filed as: NORTHERN INSURING AGENCY | 171 MARGARET ST PLATTSBURGH, NY 12901 | EBPA, LLC | — | $2K | $2K | — |
| RELPH ROBERT G AGENCY INC3 Filed as: RELPH BENEFIT ADVISORS | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | EBPA, LLC | — | $2K | $2K | — |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 400 WILLOW BROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | COMPANION LIFE INSURANCE COMPANY | $4K | $3K | $7K | — |
| ROBERT G. RELPH AGENCY, INC.5 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $2K | $4K | — |
| ROBERT G. RELPH AGENCY, INC.5 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK STE 40 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $1K | $5K | — |
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 | 419 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 419 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 305 | $2.8M |
| Dental | EBPA, LLC | 292 | $0 |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 262 | $0 |
| Life insurance(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 406 | $0 |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 406 | $0 |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 406 | $0 |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 305 | $2.8M |
| Other | MUTUAL OF OMAHA INSURANCE COMPANY | 406 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 406 | — |
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.