| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE BENEFITS SERVICES GROUP INC3 Filed as: BENEFITS SERVICES GROUP INC | P.O. BOX 6147 WATERTOWN, NY 13601 | HM LIFE INSURANCE COMPANY OF NEW YORK | $25K | — | $25K | 11.43% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | HM LIFE INSURANCE COMPANY OF NEW YORK | $8K | — | $8K | 3.57% |
| HR BENEFITS SERVICE INC3 Filed as: BENEFITS SERVICE GROUP INC | 142 ARCADE STREET WATERTOWN, NY 13601 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $3K | $6K | 9.58% |
| RELPH ROBERT G AGENCY INC3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 3.96% |
| ALLIANCE ADVISORY GRP INC3 | 350 ESSJAY ROAD WILLIAMSVILLE, NY 14221 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $50 | — | $50 | 0.08% |
| ALLIANCE ADVISORY GRP INC3 | 350 ESSJAY ROAD WILLIAMSVILLE, NY 14221 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16 | — | $16 | 0.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBS-RMSCO INC EIN 16-1171765 THIRD PARTY ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Insurance agents and brokers Service code 12 | — | $111K |
| MULTIPLAN INC. PRIVATE HEALTH EIN 13-3068979 ADMINISTRATION | Contract Administrator Service code 13 | — | $5K |
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 | 354 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 354 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 42 | $63K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 42 | $63K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY OF NEW YORK | 354 | $218K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 42 | $63K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 354 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.