| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOE FERNANDEZ3 | 1201 ELM STREET SUITE 4250 DALLAS, TX 752702111 | COMBINED INSURANCE COMPANY OF AMERICA | $57K | — | $57K | 20.40% |
| MARSH & MCLENNAN AGENCY LLC3 | 2300 RENAISSANCE BLVD. KING OF PRUSSIA, PA 194062772 | COMBINED INSURANCE COMPANY OF AMERICA | $21K | — | $21K | 7.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL MIDWEST LTD. | 55 EAST JACKSON BLVD. FLOOR 14 CHICAGO, IL 606044466 | COMBINED INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 0.90% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | ARAG INSURANCE COMPANY | $5K | — | $5K | 9.95% |
| MARSH & MCLENNAN AGENCY LLC3 | 101 HUNTINGTON AVE STE 401 BOSTON, MA 02199 | ARAG INSURANCE COMPANY | $25 | — | $25 | 0.05% |
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 | 1,303 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 18 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,321 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 322 | $3.4M |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 1,659 | $71K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,303 | $461K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,303 | $461K |
| Prescription drug | SUTTER HEALTH PLAN | 147 | $1.0M |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 3,004 | $793K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,004 | — |
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.