| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIDELITY HEALTH INSURANCE SERVICES3 | 26 NELSON ST KINGSTON, MA 02364 | PROVIDENCE HEALTH PLAN | $88K | — | $88K | 4.53% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 111 SW COLUMBIA ST. STE 500 PORTLAND, OR 97201 | PROVIDENCE HEALTH PLAN | $8K | — | $8K | 0.42% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $27 | $27 | 0.01% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD BOSTON, MA 02210 | PACIFICSOURCE HEALTH PLANS | $7K | — | $7K | 4.54% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 111 SW COLUMBIA ST STE 500 PORTLAND, OR 97201 | PACIFICSOURCE HEALTH PLANS | $556 | — | $556 | 0.38% |
| FIDELITY HEALTH INSURANCE SERVICES3 | 200 SEAPORT BLVD BOSTON, MA 02210 | VISION SERVICE PLAN | $974 | — | $974 | 5.04% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | VISION SERVICE PLAN | $160 | — | $160 | 0.83% |
| VARIOUS - SEE ATTACHED3 Filed as: VARIOUS- SEE ATTACHNENT | P.O. BOX 427 COLUMBIA, SC 29202 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5K | — | $5K | 34.91% |
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 | 139 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLAN | 353 | $2.0M |
| Dental(2 contracts, 2 carriers) | PACIFICSOURCE HEALTH PLANS | 342 | $161K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 96 | $34K |
| Life insurance(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 141 | $380K |
| Short-term disability(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 141 | $380K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 141 | $366K |
| Prescription drug | PROVIDENCE HEALTH PLAN | 353 | $1.9M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 141 | $366K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 353 | — |
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.