| 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 | EXCELLUS BLUECROSS BLUESHIELD | $51K | — | $51K | 4.10% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $5K | $6K | $11K | 9.86% |
| NATIONAL BENEFIT CENTER3 Filed as: NATIONAL BENEFIT CENTER, LLC | 1105 NORTH MARKET STREET SUITE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $92 | — | $92 | 0.08% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | COMPANION LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | SUN LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 12.42% |
| 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 | $681 | — | $681 | 10.00% |
| ROBERT G. RELPH AGENCY, INC.3 | 400 WILLOWBROOK OFFICE PARK SUITE 400 FAIRPORT, NY 14450 | MUTUAL OF OMAHA INSURANCE COMPANY | $170 | — | $170 | 10.02% |
No Schedule C service providers reported on this filing.
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 | 170 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | EXCELLUS BLUECROSS BLUESHIELD | 141 | $1.3M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 151 | $109K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 151 | $109K |
| Life insurance(4 contracts, 3 carriers) | COMPANION LIFE INSURANCE COMPANY | 170 | $33K |
| Short-term disability(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 149 | $24K |
| Long-term disability(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY | 149 | $30K |
| Prescription drug | EXCELLUS BLUECROSS BLUESHIELD | 141 | $1.2M |
| Other(2 contracts, 2 carriers) | SUN LIFE AND HEALTH INSURANCE COMPANY | 170 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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.