| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NOVA HEALTHCARE ADMINISTRATORS, INC3 | 6400 MAIN STREET, SUITE 210 BUFFALO, NY 14221 | HCC LIFE INSURANCE COMPANY | $69K | — | $69K | 14.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 74 BROWNS RACE, SUITE 200 ROCHESTER, NY 14614 | SYMETRA LIFE INSURANCE COMPANY | $15K | $3K | $18K | 18.37% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY INC. | 74 BROWNS RACE, SUITE 200 ROCHESTER, NY 14614 | FIRST UNUM LIFE INSURANCE COMPANY | $11K | — | $11K | 16.29% |
| PRISELAC & ASSOCIATES3 | ATTN MICHAEL RIZZO BUFFALO, NY 14202 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | — | $1K | 1.73% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: GILROY, KERNAN & GILROY, INC. | P.O. BOX 542 NEW HARTFORD, NY 13413 | FIRST UNUM LIFE INSURANCE COMPANY | $14 | — | $14 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INDEPENDENT HEALTH CORPORATION EIN 16-1237733 SERVICE PROVIDER | Claims processing Service code 12 | — | $125K |
| HR BENEFIT ADVISORS, LTD EIN 16-1455424 CONSULTANT | Consulting (pension) Service code 17 | — | $36K |
| DENTAL PAY PLUS, INC. DBA PRO BENEF EIN 16-1514371 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $17K |
| MEDTRAKRX EIN 36-4221427 PBM | Claims processing Service code 12 | — | $6K |
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 | 443 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 443 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EASTERN VISION SERVICE PLAN, INC. | 199 | $26K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 443 | $98K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 312 | $492K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 153 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 443 | — |
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.