| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | MVP HEALTHCARE | $107K | — | $107K | 3.52% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | SYMETRA LIFE INSURANCE COMPANY | $8K | $2K | $10K | 14.80% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | MUTUAL OF OMAHA INSURANCE COMPANY | $4K | $3K | $7K | 12.54% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | MUTUAL OF OMAHA INSURANCE COMPANY | — | $2K | $2K | 3.30% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $3K | $6K | 10.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 SELF-FUNDED DENTAL | Claims processing Service code 12 | — | $18K |
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 | 389 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 389 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MVP HEALTHCARE | 529 | $3.0M |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 269 | $53K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 389 | $69K |
| Short-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 110 | $54K |
| Other | SYMETRA LIFE INSURANCE COMPANY | 389 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 529 | — |
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.