| 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 | $38K | — | $38K | 3.25% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM ST SUITE 200 SYRACUSE, NY 14450 | EXCELLUS BLUE CROSS BLUE SHIELD | $10K | — | $10K | 0.90% |
| ROBET G RELPH AGENCY INC3 Filed as: ROBET G RELPH AGENCY | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | $2K | — | $2K | 8.67% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 6830 COCHRAN ROAD SOLON, OH 44139 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | — | $913 | $913 | 4.79% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK | 500 PLUM ST SUITE 200 SYRACUSE, NY 13204 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | $651 | — | $651 | 3.41% |
| 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 | $2K | $900 | $3K | 18.50% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHAN ROAD SOLON, OH 44139 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $527 | $527 | 3.39% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM ST SUITE 200 SYRACUSE, NY 13204 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | $356 | — | $356 | 2.29% |
| 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 | $1K | $779 | $2K | 13.36% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM ST SUITE 200 SYRACUSE, NY 13204 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $244 | — | $244 | 1.82% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 22113 FABCO RD WATERTOWN, NY 13601 | FIRST UNUM LIFE INSURANCE COMPANY | $47 | — | $47 | 11.08% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS EIN 16-1171765 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $6K |
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 | 133 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 133 | $1.2M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 117 | $13K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | 122 | $19K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 48 | $16K |
| Prescription drug | EXCELLUS BLUE CROSS BLUE SHIELD | 133 | $1.2M |
| Other(2 contracts, 2 carriers) | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | 122 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.