| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK, STE 400 WILLOWBROOK OFFICE PARK FAIRPORT, NY 14450 | EXCELLUS BLUE CROSS BLUE SHIELD | $35K | $0 | $35K | 3.77% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK, STE 400 WILLOWBROOK OFFICE PARK FAIRPORT, NY 14450 | EXCELLUS BLUECROSS BLUESHIELD | $7K | $0 | $7K | 6.82% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK, STE 400 WILLOWBROOK OFFICE PARK FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $3K | $0 | $3K | 10.83% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK, STE 400 WILLOWBROOK OFFICE PARK FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $1K | $3K | 14.44% |
| FOY BENEFITS INC3 | 120 WASHINGTON ST, STE 22 WATERTOWN, NY 13601 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $170 | $0 | $170 | 0.79% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 1105 N MARKET ST, STE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $32 | $0 | $32 | 0.15% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK, STE 400 WILLOWBROOK OFFICE PARK FAIRPORT, NY 14450 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 12.16% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 6830 COCHRAN RD SOLON, OH 44139 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $0 | $462 | $462 | 3.99% |
No Schedule C service providers reported on this filing.
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 | 345 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 345 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 124 | $919K |
| Dental | EXCELLUS BLUECROSS BLUESHIELD | 139 | $106K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 127 | $21K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 345 | $12K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 345 | $30K |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 345 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 345 | — |
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."
No prospect flags tripped on this filing.