| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFITS ADVISORS | 21300 VICTORY BLVD SUITE 635 WOODLAND HILLS, CA 91367 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $251K | $0 | $251K | 1.59% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFIT ADVISORS | 321 N. CLARK STREET CHICAGO, IL 60654 | LIBERTY MUTUAL ASSURANCE COMPANY OF BOSTON | — | $278K | $278K | 3.20% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFITS ADVISORS | 21300 VICTORY BLVD SUITE 635 WOODLAND HILLS, CA 91367 | VISION SERVICE PLAN | $5K | $58K | $63K | 2.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFIT ADVISORS | 321 N.CLARK STREET CHICAGO, IL 60654 | LIBERTY MUTUAL ASSURANCE COMPANY OF BOSTON | — | $12 | $12 | 0.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: PACIFIC RESOURCES BENEFITS ADVISORS | 21300 VICTORY BLVD, SUITE 635 WOODLAND HILLS, CA 91367 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 1.66% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $10K | $10K | — |
| UNITED BEHAVIORAL HEALTH DBA OPTUM5 | 425 MARKET STREET 14TH FLOOR SAN FRANCISCO, CA 94105 | UNITED BEHAVIORAL HEALTH DBA OPTUM | — | $714K | $714K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRUDENTIAL INSURANCE COMPANY OF AME EIN 22-1211670 INSURANCE PROVIDER | Insurance services Service code 23 | 2 RAVINIA DRIVE SUITE 1650 ATLANTA, GA 30346 | $0 |
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 | 28,749 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 74 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 53 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 28,876 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | LIBERTY MUTUAL ASSURANCE COMPANY OF BOSTON | 27,768 | $659K |
| Vision | VISION SERVICE PLAN | 22,565 | $3.1M |
| Life insurance(2 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 48,525 | $16.1M |
| Long-term disability | LIBERTY MUTUAL ASSURANCE COMPANY OF BOSTON | 28,084 | $454K |
| Prescription drug | LIBERTY MUTUAL ASSURANCE COMPANY OF BOSTON | 27,774 | $8.7M |
| Other(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 48,525 | $16.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 48,525 | — |
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.