| 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 | AETNA LIFE INSURANCE CO. | — | $33K | $33K | 6.54% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. | 965 GREENTREE RD SUITE 310 PITTSBURGH, PA 15220 | AETNA LIFE INSURANCE CO. | — | $22K | $22K | 4.25% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $264 | $264 | 0.24% |
| ROBERT G. RELPH AGENCY, INC.3 | 800 PARKER HILL DRIVE SUITE 100 ROCHESTER, NY 14625 | HM LIFE INSURANCE COMPANY (DAVISVISION) | $6K | — | $6K | 10.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $91 | $91 | 0.25% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | — | $71 | $71 | 0.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE, INC EIN 23-7391136 THIRD PARTY ADMINISTRATOR | Claims processing; Insurance brokerage commissions and fees; Contract Administrator; Float revenue; Other services; Insurance agents and brokers; Other commissions; Non-monetary compensation; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $369K |
| INGENIORX, INC. EIN 82-3062245 THIRD PARTY ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing; Float revenue; Contract Administrator Service code 12 | — | -$38K |
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 | 540 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 540 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | EMPIRE HEALTHCHOICE ASSURANCE, INC | 569 | $1.0M |
| Vision | HM LIFE INSURANCE COMPANY (DAVISVISION) | 444 | $64K |
| Life insurance(2 contracts) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 540 | $140K |
| Long-term disability | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 171 | $36K |
| Stop-loss / reinsurancereinsurance | EMPIRE HEALTHCHOICE ASSURANCE, INC | 569 | $1.0M |
| Other(2 contracts) | LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | 540 | $140K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 569 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.