| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | EXCELLUS BLUECROSS BLUESHIELD | $15K | — | $15K | 4.24% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | EXCELLUS BLUECROSS BLUESHIELD | $18K | — | $18K | 16.79% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 MEDICAL W/RX | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $487K |
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 | 806 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 806 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 107 | $365K |
| Stop-loss / reinsurancereinsurance | EXCELLUS BLUECROSS BLUESHIELD | 806 | $110K |
| Other | EMPLOYEE SERVICES, INC. (ESI GROUP) | 772 | $20K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 806 | — |
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.