Form 5500 · Employee benefit plan · ROME, NY
ROME MEMORIAL HOSPITAL
The filing calls this plan ROME MEMORIAL HOSPITAL DBA ROME HEALTH WELFARE BENEFITS PLAN.
ROME MEMORIAL HOSPITAL of ROME, NY insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is ROBERT G RELPH AGENCY INC.. Coverage is written through MVP HEALTH SERVICES CORP and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 16-1471634 · plan 520 · plan year 2025, filed Jul 20, 2026
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3,536 other employer plans in New York have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision, life and disability; the largest, with MVP HEALTH SERVICES CORP, covers 706 people.
Reported premium across the insured contracts is $6,519,698, with $246,632 in disclosed broker commissions — about 3.8% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
ROBERT G RELPH AGENCY INC. is the broker of record on all 5 contracts.
3 carriers appear on the filing, including MVP HEALTH SERVICES CORP, SYMETRA LIFE INSURANCE COMPANY and METROPOLITAN LIFE INSURANCE COMPANY. MVP HEALTH SERVICES CORP writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| MVP HEALTH SERVICES CORP | Health | 706 | Jan 1, 2026 | $5,313,577 | $155,632 |
| SYMETRA LIFE INSURANCE COMPANY | Life, Disability | 799 | Jan 1, 2026 | $694,336 | $71,378 |
| METROPOLITAN LIFE INSURANCE COMPANY | Dental, Vision | 975 | Jan 1, 2026 | $484,869 | $16,578 |
| METROPOLITAN LIFE INSURANCE COMPANY | — | 186 | Jan 1, 2026 | $14,038 | $1,765 |
| METROPOLITAN LIFE INSURANCE COMPANY | — | 119 | Jan 1, 2027 | $12,878 | $1,279 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
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