| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | HARTFORD LIFE AND ACCIDENT | $0 | $12K | $12K | 1.49% |
| AON CONSULTING INC3 Filed as: AON RISK SERVICES CENTRAL, INC. | PO BOX 955816 SAINT LOUIS, MO 63195 | HARTFORD LIFE AND ACCIDENT | $0 | $136 | $136 | 0.02% |
| LOCKTON COMPANIES, LLC4 | 3280 PEACHTREE ROAD NE, SUITE 250 ATLANTA, GA 30305 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $3K | $0 | $3K | 10.00% |
| BARRY OLFERN AND ASSOC. INC4 Filed as: BARRY OLFERN AND ASSOCIATES, INC. | 954 TYLER STREET HOLLYWOOD, FL 33019 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $2K | $0 | $2K | 4.70% |
| TOMAS M. DIEBOLD4 | 2517 SE CARPENTER STREET PORT ST LUCIE, FL 34984 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $1K | $0 | $1K | 3.70% |
| EMILY J. DIEBOLD4 | 2517 SE CARPENTER STREET PORT ST LUCIE, FL 34984 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $551 | $0 | $551 | 1.60% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | HARTFORD FIRE INSURANCE COMPANY | $5K | $281 | $5K | 21.24% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA, INC. NONE | Claims processing; Direct payment from the plan Service code 12 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $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 | 3,759 | 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) | 3,759 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 30 | $216 |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | 1,715 | $136K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 3,759 | $780K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 3,759 | $780K |
| Other(5 contracts, 5 carriers) | HARTFORD LIFE AND ACCIDENT | 6,970 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,970 | — |
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.