| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 800 PARKER HILL DR STE 100 ROCHESTER, NY 14625 | EMPIRE HEALTHCHOICE ASSURANCE | $61K | — | $61K | 8.24% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 800 PARKER HILL DRIVE STE 100 ROCHESTER, NY 14625 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $35K | — | $35K | 9.18% |
| RELPH ROBERT G AGENCY INC3 Filed as: RELPH BENEFIT ADVISORS | 800 PARKER HILL DRIVE STE 100 ROCHESTER, NY 14625 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $11K | — | $11K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. EIN 23-7391136 THIRD PARTY ADMINISTRATOR | Float revenue; Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $727K |
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 | 2,208 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 2,208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 45 | $533K |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE | 1,503 | $735K |
| Life insurance | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 2,208 | $376K |
| Short-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 2,208 | $376K |
| Long-term disability | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 2,208 | $376K |
| Other(4 contracts, 4 carriers) | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 2,208 | $502K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,208 | — |
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.