| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BOLLINGER INC3 | 200 JEFFERSON PARK WHIPPANY, NJ 079811054 | METLIFE | $6K | — | $6K | 2.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | PO BOX 95287 CHICAGO, IL 60006 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $12K | — | $12K | 6.17% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 250 PARK AVENUE 3RD FLOOR NEW YORK, NY 10177 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 5.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | ARTHUR J GALLAGHER CO-SUITE 300 400 MIDLAND DRIVE MT LAUREL, NJ 08054 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 1.10% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | GOLF ROAD ROLLONGS MEADOWS, IL 60008 | AETNA LIFE INSURANCE COMPANY | $3K | — | $3K | 9.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | — | AETNA LIFE INSURANCE COMPANY | — | $118 | $118 | 0.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 300 MADISON AVENUE 28TH FLOOR NEW YORK, NY 10017 | GUARDIAN | $3K | — | $3K | 11.87% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | 300 MADISON AVENUE 28TH FLOOR NEW YOR, NY 10017 | GUARDIAN | — | $556 | $556 | 2.45% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 200 JEFFERSON PARK WHIPPANY, NJ 07981 | METLIFE LEGAL PLANS | $1K | — | $1K | 10.22% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | PO BOX 95287 CHICAGO, IL 60694 | METLIFE LEGAL PLANS | — | $39 | $39 | 0.38% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES OF CALIF | 505 NORTH BRAND BOULEVARD 6TH FLOOR GLENDALE, CA 912033944 | METLIFE LEGAL PLANS | — | $15 | $15 | 0.15% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVENUE OF THE AMERICAS 34TH FLOOR NEW YORK, NY 10036 | THE HARTFORD | $1K | — | $1K | 25.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 1166 AVENUE OF THE AMERICAS 34TH FLOOR NEW YORK, NY 10036 | THE HARTFORD | — | $82 | $82 | 1.49% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX INC EIN 33-0441200 PHARMACY BENEFIT MANAGEME | Claims processing; Direct payment from the plan; Other fees; Float revenue Service code 12 | — | $561K |
| AETNA LIFE INSURANCE EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $350K |
| AETNA BEHAVIORAL HEALTH LLC EIN 06-6033492 PLAN ADMINISTRATOR | Contract Administrator Service code 13 | — | $4K |
| PRUDENTIAL INSURANCE COMPANY OF AME EIN 22-1211670 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $279 |
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 | 420 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 436 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | METLIFE | 299 | $232K |
| Vision | AETNA LIFE INSURANCE COMPANY | 224 | $26K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 420 | $169K |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 420 | $207K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 420 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.