| 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 | UNIVERA HEALTHCARE | $30K | — | $30K | 1.23% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 7.66% |
| 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) | $3K | — | $3K | 10.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY INC. | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | COMPANION LIFE INSURANCE COMPANY | $736 | $254 | $990 | 13.44% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | COMPANION LIFE INSURANCE COMPANY | — | $218 | $218 | 2.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| COMTON, INC. EIN 16-1554883 THIRD PARTY ADMINISTRATOR | Claims processing; Contract Administrator; Insurance agents and brokers Service code 12 | — | $15K |
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 | 368 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIVERA HEALTHCARE | 248 | $2.4M |
| Vision | HM LIFE INSURANCE COMPANY OF NEW YORK (DAVIS VISION) | 257 | $27K |
| Life insurance(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 368 | $101K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 368 | $93K |
| Prescription drug | UNIVERA HEALTHCARE | 248 | $2.4M |
| Other | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 368 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 368 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
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.