| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRUCE ANDREW ROTH3 Filed as: BRUCE ROTH | 990 HAMMOND DRIVE SUITE 830 ATLANTA, GA 30328 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $120K | — | $120K | 10.83% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $669 | $669 | 0.15% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO NY | $2K | — | $2K | 3.39% |
| BRUCE A ROTH CLU CHFC3 | 990 HAMMOND DRIVE SUITE 830 ATLANTA, GA 30328 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 10.00% |
| STUART A. KLEIN4 | 29 HARBOR POINTE DRIVE HAVERSTRAW, NY 10927 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $1K | — | $1K | 8.86% |
| JACQUELYNN A. KONKLE4 | W2143 LODWING STREET FREEDOM, WI 54130 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $860 | — | $860 | 7.18% |
| LEVITT-FUIRST ASSOCIATES, LTD.3 | ONE EXECUTIVE BLVD YONKERS, NY 10701 | FEDERAL INSURANCE COMPANY | $757 | $37 | $794 | 15.72% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO NY | $6 | — | $6 | 4.23% |
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 | 1,426 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,432 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED BEHAVIORAL HEALTH DBA OPTUM | 1,199 | $38K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 2,140 | $455K |
| Vision(2 contracts) | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO NY | 1,326 | $74K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,405 | $1.1M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,405 | $1.1M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,405 | $1.1M |
| Other(5 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,426 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,140 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.