| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $6K | $6K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $4K | — | $4K | 2.82% |
| 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 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4K | — | $4K | 3.77% |
| 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 | 4.93% |
| 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 | $9K | $5K | $14K | 15.74% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER LLC | 1105 N MARKET STREET SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $79 | — | $79 | 0.09% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $5K | — | $5K | 6.84% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $3K | $3K | 4.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $1K | — | $1K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | — | $295 | $295 | 4.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 SELF FUNDED MEDICAL | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $191K |
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 | 577 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 577 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | MVP HEALTH CARE | 32 | $130K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 475 | $87K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 475 | $87K |
| Life insurance | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 577 | $151K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 577 | $105K |
| Long-term disability | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 577 | $68K |
| Other | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | 577 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 577 | — |
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.