| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | EMPIRE HEALTHCHOICE ASSURANCE, INC. | $136K | — | $136K | 1.99% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $16K | — | $16K | 6.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | MUTUAL OF OMAHA INSURANCE COMPANY - JORDACHE ENTERPRISES | $28K | — | $28K | 19.98% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | UNITED OF OMAHA LIFE INSURANCE - JORDACHE ENTERPRISES | $9K | — | $9K | 15.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | MUTUAL OF OMAHA INSURANCE COMPANY - DITTO APPAREL | $2K | — | $2K | 20.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | UNITED OF OMAHA LIFE INSURANCE COMPANY - DITTO APPAREL | $2K | — | $2K | 20.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH MCLENNAN AGENCY, LLC | PARK 80 WEST, PLAZA TWO 250 PEHLE AVENUE, SUITE 400 SADDLE BROOK, NJ 07663 | COMPANION LIFE INSURANCE COMPANY - JORDACHE ENTERPRISES | $287 | — | $287 | 12.51% |
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 | 774 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 783 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 442 | $6.8M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 465 | $260K |
| Vision | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 442 | $6.8M |
| Life insurance(3 contracts, 3 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY - JORDACHE ENTERPRISES | 537 | $151K |
| Long-term disability(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE - JORDACHE ENTERPRISES | 162 | $72K |
| Prescription drug | EMPIRE HEALTHCHOICE ASSURANCE, INC. | 442 | $6.8M |
| Other(2 contracts, 2 carriers) | MUTUAL OF OMAHA INSURANCE COMPANY - JORDACHE ENTERPRISES | 537 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 537 | — |
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.