| 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 | $71K | — | $71K | 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 | $16K | $3K | $19K | 17.27% |
| RELPH ROBERT G AGENCY INC3 Filed as: RELPH ROBERT G. AGENCY INC. | 74 BROWNS RACE, STE 200 ROCHESTER, NY 14614 | HARTFORD LIFE AND ACCIDENT | $5K | — | $5K | 6.64% |
| RELPH ROBERT G AGENCY INC3 Filed as: RELPH ROBERT G. AGENCY INC. | 74 BROWNS RACE, STE 200 ROCHESTER, NY 14614 | HARTFORD LIFE AND ACCIDENT | $4K | — | $4K | 5.71% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE, SUITE 100 ROCHESTER, NY 14625 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | $968 | $5K | 14.15% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY | 74 BROWNS RACE, SUITE 200 ROCHESTER, NY 14614 | EASTERN VISION SERVICE PLAN, INC. | $1K | — | $1K | 4.91% |
| 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 | $999 | — | $999 | 17.89% |
| PRISELAC & ASSOCIATES3 | ATTN MICHAEL RIZZO BUFFALO, NY 14202 | FIRST UNUM LIFE INSURANCE COMPANY | $80 | — | $80 | 1.43% |
| WORLD INSURANCE ASSOCIATES LLC3 Filed as: GILROY, KERNAN & GILROY, INC. | P.O. BOX 542 NEW HARTFORD, NY 13413 | FIRST UNUM LIFE INSURANCE COMPANY | $1 | — | $1 | 0.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INDEPENDENT HEALTH CORPORATION EIN 16-1237733 SERVICE PROVIDER | Claims processing Service code 12 | — | $126K |
| HR BENEFIT ADVISORS, LTD EIN 16-1455424 CONSULTANT | Consulting (pension) Service code 17 | — | $40K |
| DENTAL PAY PLUS, INC. DBA PRO BENEF EIN 16-1514371 CLAIMS ADMINISTRATOR | Claims processing Service code 12 | — | $18K |
| 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 | 473 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 473 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EASTERN VISION SERVICE PLAN, INC. | 212 | $28K |
| Life insurance | SYMETRA LIFE INSURANCE COMPANY | 473 | $111K |
| Short-term disability(2 contracts) | HARTFORD LIFE AND ACCIDENT | 452 | $138K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 254 | $33K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 300 | $506K |
| Other | FIRST UNUM LIFE INSURANCE COMPANY | 0 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 473 | — |
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.