| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $3K | $1K | $4K | 10.35% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | $2K | $4K | 10.06% |
| MARKETING ASSOCIATES & LIMITED COMP3 Filed as: MARKETING ASSOC & LTD | — | AXA EQUITABLE LIFE INSURANCE COMPANY | $4K | — | $4K | 19.81% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | HM LIFE INSURANCE COMPANY OF NEW YORK (DAVIS VISION) | $2K | — | $2K | 10.88% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $469 | $133 | $602 | 12.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD EIN 16-1093854 THIRD PARTY ADMINISTRATOR | Claims processing Service code 12 | — | $187K |
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 | 402 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 402 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK (DAVIS VISION) | 163 | $17K |
| Life insurance(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 402 | $60K |
| Long-term disability | MUTUAL OF OMAHA INSURANCE COMPANY | 402 | $39K |
| Other(2 contracts, 2 carriers) | EMPLOYEE NETWORK, INC | 397 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 402 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.