| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK, STE 40 FAIRPORT, NY 14450 | COMPANION LIFE INSURANCE COMPANY | $5K | $3K | $8K | 8.71% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | COMPANION LIFE INSURANCE COMPANY | — | $2K | $2K | 2.61% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK, STE 40 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $687 | $3K | 12.57% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $589 | $589 | 2.20% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK, STE 40 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | $416 | $2K | 13.11% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $356 | $356 | 2.67% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 800 PARKER HILL DRIVE, SUITE 100 ROCHESTER, NY 14625 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | — | $2K | 17.00% |
| 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 | $78K | — | $78K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBPA LLC EIN 20-1879465 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | PO BOX 2365 BURLINGTON, VT 05407 | $13K |
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 | 437 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 437 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | COMPANION LIFE INSURANCE COMPANY | 303 | $87K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 72 | $27K |
| Prescription drug | HIGHMARK NORTHEASTERN NEW YORK | 437 | $0 |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 303 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 437 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.