| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | CAPITAL DISTRICT PHYSICIAN'S HEALTH PLAN INC. | $67K | — | $67K | 7.14% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | HM LIFE INSURANCE COMPANY (DAVISVISION) | $6K | — | $6K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC EIN 23-7391136 THIRD PARTY ADMINISTRATOR | Contract Administrator; Claims processing; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $270K |
| INGENIORX, INC EIN 82-3062245 THIRD PARTY ADMINISTRATOR | Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Contract Administrator Service code 12 | — | $16K |
| ROBERT G RELPH AGENCY, INC EIN 16-1181862 THIRD PARTY ADMINISTRATOR | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | — | $0 |
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 | 533 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 533 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CAPITAL DISTRICT PHYSICIAN'S HEALTH PLAN INC. | 505 | $1.5M |
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC | 534 | $350K |
| Vision | HM LIFE INSURANCE COMPANY (DAVISVISION) | 842 | $60K |
| Life insurance(2 contracts) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 533 | $121K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 164 | $34K |
| Other(2 contracts) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 533 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 842 | — |
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."
No prospect flags tripped on this filing.