| 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 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $77 | $4K | 2.83% |
| NATIONAL BENENFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA GROUP INSURANCE | -$132 | $2K | $2K | 1.99% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARTKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | CIGNA GROUP INSURANCE | $1K | — | $1K | 1.43% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | 101 GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | CIGNA GROUP INSURANCE | -$66 | $908 | $842 | 0.80% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | $2K | — | $2K | 4.10% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | — | $1K | $1K | 1.90% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | INC. 101 S GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | — | $427 | $427 | 0.77% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | NEW YORK LIFE INSURANCE COMPANY OF NY | $2K | — | $2K | 6.83% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | NEW YORK LIFE INSURANCE COMPANY OF NY | -$48 | $628 | $580 | 2.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 | INC 101 S GARLAND AVENUE SUITE 203 ORLANDO, FL 32801 | NEW YORK LIFE INSURANCE COMPANY OF NY | -$24 | $251 | $227 | 0.78% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | EYEMED VISION CARE | $2K | — | $2K | 8.59% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 13625 | CIGNA GROUP INSURANCE | $2K | — | $2K | 13.37% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | CIGNA GROUP INSURANCE | — | $216 | $216 | 1.85% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | EYEMED VISION CARE | $1K | — | $1K | 149.44% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNIVERA HEALTHCARE EIN 16-0743900 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $170K |
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 | 535 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 195 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 730 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 438 | $132K |
| Vision(2 contracts) | EYEMED VISION CARE | 432 | $28K |
| Life insurance | CIGNA GROUP INSURANCE | 656 | $105K |
| Short-term disability | NEW YORK LIFE INSURANCE COMPANY OF NY | 231 | $29K |
| Long-term disability | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | 464 | $56K |
| Other(2 contracts) | CIGNA GROUP INSURANCE | 656 | $117K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 656 | — |
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.