| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE INC. | 7500 OLD GEORGETOWN RD - STE 1225 BETHESDA, MD 20814 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 2.79% |
| MERCER HEALTH AND BENEFITS, LLC3 | 155 N WACKER DRIVE, SUITE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC | $5K | — | $5K | 2.21% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE INC. | 160 FEDERAL ST - 4TH FLOOR BOSTON, MA 02110 | DELTA DENTAL OF CALIFORNIA | $11K | — | $11K | 5.78% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | DELTA DENTAL OF CALIFORNIA | $8K | — | $8K | 4.21% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL STREET, 4TH FLOOR BOSTON, MA 02110 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 6.56% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 6.25% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $41 | $41 | 0.03% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE INC. | 160 FEDERAL ST - 4TH FLOOR BOSTON, MA 02110 | VISION SERVICE PLAN | $617 | — | $617 | 2.87% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | VISION SERVICE PLAN | $450 | — | $450 | 2.10% |
| RSC INSURANCE BROKERAGE INC3 | 160 FEDERAL ST - 4TH FLOOR BOSTON, MA 02110 | DELTA DENTAL OF CALIFORNIA | $780 | — | $780 | 5.62% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 02110 | DELTA DENTAL OF CALIFORNIA | $600 | — | $600 | 4.32% |
| MASOLI LEGACY LLC3 | 4319 BLENHEIM WAY CONCORD, CA 94521 | PRE-PAID LEGAL SERVICES INC. | $295 | — | $295 | 7.80% |
| MERCER HEALTH AND BENEFITS, LLC4 Filed as: MERCER HEALTH & BENEFITS LLC | PO BOX 850502 MINNEAPOLIS, MN 55485 | PRE-PAID LEGAL SERVICES INC. | $200 | — | $200 | 5.29% |
| CHERYL A. COBBIN4 Filed as: CHERYL A COBBIN | 2931 TILDEN DRIVE ROSEVILLE, CA 95678 | PRE-PAID LEGAL SERVICES INC. | $88 | — | $88 | 2.33% |
| WARREN G BENDER CO4 | 516 GIBSON DRIVE - STE 240 ROSEVILLE, CA 95678 | PRE-PAID LEGAL SERVICES INC. | $78 | — | $78 | 2.06% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 22 | $234K |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 260 | $205K |
| Vision | VISION SERVICE PLAN | 147 | $21K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $121K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $121K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $121K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 22 | $234K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 186 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 260 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.