| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | PO BOX 948 HENRIETTA, NY 14667 | HEALTHKEEPERS, INC. | $18K | — | $18K | 2.95% |
| JAMES A SCOTT & SON INC3 | 628 GREEN VALLEY ROAD SUITE 306 GREENSBORO, NC 27408 | HEALTHKEEPERS, INC. | $2K | — | $2K | 0.30% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 225 KENNETH DRIVE ROCHESTER, NY 14623 | DELTA DENTAL OF VIRGINIA | $2K | — | $2K | 4.02% |
| JAMES A SCOTT & SON INC3 | 1301 OLD GRAVES MILL ROAD LYNCHBURG, VA 24502 | DELTA DENTAL OF VIRGINIA | $418 | — | $418 | 0.98% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | UNITEDHEALTHCARE INSURANCE COMPANY | $680 | — | $680 | 5.86% |
| PAYCHEX INSURANCE AGENCY, INC.3 | 225 KENNETH DRIVE ROCHESTER, NY 14623 | UNITEDHEALTHCARE INSURANCE COMPANY | $810 | — | $810 | 8.09% |
| JAMES A SCOTT & SON INC3 | 1301 OLD GRAVES MILL ROAD LYNCHBURG, VA 24502 | UNITEDHEALTHCARE INSURANCE COMPANY | $192 | — | $192 | 1.92% |
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 | 136 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTHKEEPERS, INC. | 93 | $593K |
| Dental | DELTA DENTAL OF VIRGINIA | 177 | $43K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 130 | $10K |
| Life insurance(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 275 | $23K |
| Other(4 contracts, 3 carriers) | HEALTHKEEPERS, INC. | 275 | $617K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.