| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $62 | $62 | 0.04% |
| VARIOUS - SEE ATTACHMENT3 | P.O. BOX 1365 COLUMBIA, SC 29202 | THE PAUL REVERE LIFE INSURANCE COMPANY | $9K | $17 | $9K | 14.99% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | FIDELITY SECURITY LIFE ASSURANCE COMPANY OF NEW YORK | $154 | — | $154 | 0.42% |
| VARIOUS - SEE ATTACHMENT3 | POST OFFICE BOX 1365 COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $144 | $2K | 14.06% |
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 | 345 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 346 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 55 | $75K |
| Vision | FIDELITY SECURITY LIFE ASSURANCE COMPANY OF NEW YORK | 479 | $37K |
| Life insurance(3 contracts, 3 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 345 | $241K |
| Short-term disability(3 contracts, 3 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 345 | $241K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 345 | $166K |
| Other(3 contracts, 3 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 345 | $241K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 479 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.