| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $10K | — | $10K | 4.45% |
| NATIONAL BENEFIT CNETER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $9K | $9K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MVP HEALTH CARE | $5K | — | $5K | 5.05% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4K | — | $4K | 4.14% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE CO. OF NEW YORK | — | $4K | $4K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $8K | $12K | $20K | 28.81% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 SELF FUNDED MEDICAL | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator 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 | 719 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 719 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MVP HEALTH CARE | 37 | $99K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 501 | $70K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 501 | $70K |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 719 | $223K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 532 | $94K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 719 | $223K |
| Other | CIGNA LIFE INSURANCE CO. OF NEW YORK | 719 | $223K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 719 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.