| 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 PK SUITE 400 FAIRPORT, NY 14450 | OXFORD HEALTH INSURANCE, INC. | $42K | — | $42K | 2.89% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G. RELPH AGENCY, INC | 400 WILLOWBROOK OFFICE PK SUITE 400 FAIRPORT, NY 14450 | CAPITAL DISTRICT PHYSICIAN'S HEALTH PLAN, INC. | $43K | — | $43K | 4.00% |
| ROSE & KIERNAN INC3 Filed as: ROSE & KIERNAN, INC. | PO BOX 640 EAST GREENBUSH, NY 12061 | METROPOLITAN LIFE INSURANCE COMPANY | $295 | $23 | $318 | 0.17% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 400 WILLOWBROOK OFFICE PK SUITE 400 FAIRPORT, NY 14450 | METROPOLITAN LIFE INSURANCE COMPANY | — | $60 | $60 | 0.03% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 400 WILLOWBROOK OFFICE PK SUITE 500 FAIRPORT, NY 14450 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $13K | $121 | $14K | 12.55% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT G RELPH AGENCY, INC. | 400 WILLOWBROOK OFFICE PK SUITE 400 FAIRPORT, NY 14450 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 7.95% |
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 | 493 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 493 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | OXFORD HEALTH INSURANCE, INC. | 285 | $2.5M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 493 | $186K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 234 | $25K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $108K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $108K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $108K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 373 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 493 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.