| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| 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 | $76K | — | $76K | 3.42% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3K | — | $3K | 12.67% |
| ROERT G RELPH AGENCY INC3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | $155 | $2K | 9.92% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | FIRST UNUM LIFE INSURANCE COMPANY | $2K | $107 | $2K | 14.42% |
| ROBERT G. RELPH AGENCY, INC. Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $195 | — | $195 | 7.57% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN & BROWN OF NEW YORK INC | 500 PLUM STREET SUITE 200 SYRACUSE, NY 13204 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $63 | — | $63 | 2.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EBS-RMSCO INC EIN 16-1171765 TPA DENTAL | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $8K |
| FLEXIBLE BENEFIT SYSTEMS EIN 16-1181862 TPA VISION | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $0 |
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 | 518 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 518 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUECROSS BLUESHIELD | 257 | $2.2M |
| Life insurance | FIRST UNUM LIFE INSURANCE COMPANY | 370 | $21K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 5 | $3K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 373 | $26K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 257 | $2.2M |
| Other(3 contracts, 2 carriers) | FIRST UNUM LIFE INSURANCE COMPANY | 518 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 518 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.