| 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 DRIVE SUITE 100 ROCHESTER, NY 14625 | EXCELLUS BLUE CROSS BLUE SHIELD | $21K | — | $21K | 7.99% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $1K | $3K | 6.25% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | FIRST UNUM LIFE INSURANCE COMPANY | $8K | $350 | $8K | 17.75% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | $3K | — | $3K | 7.01% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | THE HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 16.33% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 15-0539129 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $385K |
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 | 780 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 780 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 473 | $313K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 446 | $52K |
| Life insurance(2 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 780 | $87K |
| Long-term disability | THE HARTFORD LIFE AND ACCIDENT | 44 | $15K |
| Other | ANTHEM LIFE & DISABILITY INSURANCE COMPANY | 780 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 780 | — |
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.