| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT RELPH AGENCY | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | HEALTHNOW NEW YORK INC. DBA BLUECROSS BLUESHIELD OF WESTERN NEW YORK | $43K | — | $43K | 2.12% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | $1K | $472 | $2K | 17.39% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | — | $419 | $419 | 4.29% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | $51 | $1K | 15.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMTON, INC. EIN 16-1554883 SELF-FUNDED DENTAL | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $9K |
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 | 251 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 251 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHNOW NEW YORK INC. DBA BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 429 | $2.0M |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | 251 | $10K |
| Long-term disability | FIRST UNUM LIFE INSURANCE COMPANY | 25 | $7K |
| Prescription drug | HEALTHNOW NEW YORK INC. DBA BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 429 | $2.0M |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY OF NEW YORK | 251 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 429 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.