| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY, INC. | 150 SAWGRASS DRIVE ROCHESTER, NY 14620 | KAISER FOUNDATION HEALTH PLAN INC | $14K | $1 | $14K | 1.52% |
| PAYCHEX INSURANCE AGENCY, INC.3 Filed as: PAYCHEX AGENCY, INC. | 225 KENNETH DRIVE ROCHESTER, NY 14623 | HARTFORD LIFE AND ACCIDENT | $32K | $0 | $32K | 20.09% |
| ANDREA SHEA3 | 6840 CAROTHERS PARKWAY, SUITE 100 FRANKLIN, TN 37067 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 8.81% |
| MICHELLE GATTIS3 | 6840 CAROTHERS PARKWAY, SUITE 100 FRANKLIN, TN 37067 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 8.81% |
| GALLAGHER BENEFIT SERVICES, INC.4 Filed as: GALLAGHER BENEFIT SERVICES | 6967 SOUTH RIVER GATE DRIVE SUITE 200 MIDVALE, UT 84047 | PREPAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | $0 | $2K | 10.51% |
| LORRAINE BACKUS4 | 1903 RIVEREDGE DRIVE ASTOR, FL 32102 | PREPAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | $0 | $1K | 7.35% |
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 | 1,862 | 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) | 1,862 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | PRIORITY HEALTH | 175 | $2.3M |
| Dental | UNIVERSITY HEALTH ALLIANCE | 36 | $298K |
| Vision(2 contracts, 2 carriers) | UNIVERSITY HEALTH ALLIANCE | 1,545 | $439K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,862 | $782K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,862 | $782K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,862 | $782K |
| Prescription drug(3 contracts, 3 carriers) | PRIORITY HEALTH | 175 | $2.3M |
| Other(4 contracts, 4 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,862 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,862 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.