| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $0 | $6K | $6K | 0.53% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $4K | $12K | 15.42% |
| JAY E. BLACK3 | 1400 MIDHURST COURT BEL AIR, MD 21014 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $528 | $0 | $528 | 0.65% |
| SONIA A VIDAL-AWBREY3 Filed as: SONIA VIDAL-AWBREY | 2665 PROSPERITY AVENUE FAIRFAX, VA 22031 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $88 | $0 | $88 | 0.11% |
| PAYCHEX INSURANCE AGENCY, INC.5 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | GROUP HOSPITALIZATION MEDICAL SERVICES INC | $0 | $1K | $1K | 1.80% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX INSURANCE AGENCY INC | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | GROUP HOSPITALIZATION MEDICAL SERVICES INC | $0 | $803 | $803 | 1.10% |
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 186 | $1.1M |
| Dental | GROUP HOSPITALIZATION MEDICAL SERVICES INC | 202 | $73K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $81K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $81K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $81K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | 186 | $1.1M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 97 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 202 | — |
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.