| 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 SUITE 400 FAIRPORT, NY 14450 | HM LIFE INSURANCE COMPANY OF NEW YORK | $0 | — | $0 | 0.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $6K | $2K | $8K | 10.77% |
| ALLIANCE ADVISORY GRP INC3 Filed as: ALLIANCE ADVISORY GROUP INC | 600 DELAWARE AVENUE BUFFALO, NY 14202 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $116 | — | $116 | 0.17% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENFIT SOLUTIONS EIN 16-1171765 THIRD PARTY ADMINISTRATOR | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $105K |
| MULTIPLAN INC. PRIVATE HEALTH EIN 13-3068979 ADMINISTRATION | Contract Administrator Service code 13 | — | $54K |
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 | 334 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 334 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 50 | $70K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 50 | $70K |
| Stop-loss / reinsurancereinsurance | HM LIFE INSURANCE COMPANY OF NEW YORK | 334 | $182K |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 50 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 334 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.