| 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 BLUE CROSS BLUE SHIELD | $45K | — | $45K | 4.20% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 400 WILLOW BROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $55K | $4K | $60K | 77.36% |
| ALLIANCE ADVISORY GRP INC3 Filed as: ALLIANCE ADVISORY GRP INC. | 350 ESSJAY ROAD SUITE 301 WILLIAMSVILLE, NY 14221 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $111 | — | $111 | 0.14% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 400 WILLOW BROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $3K | $2K | $5K | 23.92% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHAN ROAD SOLON, OH 44139 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $771 | $771 | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 400 WILLOW BROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | $2K | $800 | $3K | 16.54% |
| NATIONAL BENEFITS CENTER LLC3 Filed as: NATIONAL BENEFITS CENTER | 6830 COCHRAN ROAD SOLON, OH 44139 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | — | $635 | $635 | 4.09% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G.RELPH AGENCY | 400 WILLOW BROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | GUARDIAN | $1K | $748 | $2K | 16.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS EIN 16-1171765 THIRD PARTY ADMINISTRATOR | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $7K |
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 | 146 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 146 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 146 | $1.1M |
| Vision | GUARDIAN | 117 | $11K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | 118 | $16K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 271 | $77K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 61 | $19K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 146 | $1.1M |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | 118 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 271 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.