| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY | PO BOX 948 HENRIETTA, NY 14467 | BLUECROSS BLUESHIELD NEBRASKA | $48K | $4 | $48K | 4.25% |
| MARCOTTE INSURANCE AGENCY INC3 | 9394 W DODGE RD STE 250 OMAHA, NE 681143319 | AMERITAS LIFE INSURANCE CORP. | $2K | $1K | $3K | 4.92% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DR ROCHESTER, NY 146204648 | AMERITAS LIFE INSURANCE CORP. | $2K | — | $2K | 2.38% |
| MARCOTTE INSURANCE AGENCY INC3 | 9394 WEST DODGE ROAD SUITE 250 OMAHA, NE 68114 | PRUDENTAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 6.87% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENEUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTAL INSURANCE COMPANY OF AMERICA | — | $74 | $74 | 0.14% |
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 | 209 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 214 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD NEBRASKA | 126 | $1.1M |
| Dental | AMERITAS LIFE INSURANCE CORP. | 253 | $66K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 253 | $66K |
| Life insurance | PRUDENTAL INSURANCE COMPANY OF AMERICA | 211 | $54K |
| Long-term disability | PRUDENTAL INSURANCE COMPANY OF AMERICA | 211 | $54K |
| Other | PRUDENTAL INSURANCE COMPANY OF AMERICA | 211 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 253 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.