| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROGERS BENEFIT GROUP INC3 | 5110 N 40TH ST SUITE 234 PHOENIX, AZ 85018 | AETNA LIFE INSURANCE CO. | $24K | $0 | $24K | 1.86% |
| JESSE M PACHECO3 | 2110 SADDLEHORN TRAIL KATY, TX 77494 | AETNA LIFE INSURANCE CO. | $21K | $0 | $21K | 1.65% |
| JESSE M PACHECO3 | 2110 SADDLEHORN TRL KATY, TX 774945631 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | $0 | $2K | 9.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| JESSE M PACHECO | Insurance agents and brokers Service code 22 | 2110 SADDLEHORN TRAIL KATY, TX 77494 | $59K |
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 | 126 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Dental | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 120 | $20K |
| Life insurance | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Short-term disability | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Long-term disability | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Prescription drug | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Other | AETNA LIFE INSURANCE CO. | 215 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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.