| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $319 | $3K | 4.30% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $75 | $1K | 1.69% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $251 | $1 | $252 | 0.39% |
| LOCKTON COMPANIES, LLC3 | PO BOX 415840 BOSTON, MA 02241 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $131 | $0 | $131 | 0.21% |
| LOCKTON COMPANIES, LLC3 | THREE EMBARCADERO CENTER SUITE 609 SAN FRANCISCO, CA 94111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $28 | $3 | $31 | 0.05% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $270 | $3K | 15.77% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $0 | $1K | 6.60% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $372 | $0 | $372 | 2.03% |
| LOCKTON COMPANIES, LLC3 | PO BOX 843844 KANSAS CITY, MO 64184 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $124 | $0 | $124 | 0.68% |
| BCINSOURCING, LLC3 | 6363 COLLEGE BOULEVARD, SUITE 500 OVERLAND PARK, KS 66211 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $124 | $0 | $124 | 0.68% |
| LOCKTON COMPANIES, LLC3 | PO BOX 415840 BOSTON, MA 02241 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $74 | $0 | $74 | 0.40% |
| MARY THERESA FISHER4 | 29C OWENS LANDING COURT PERRYVILLE, MD 21903 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $1K | $0 | $1K | 5.77% |
| LOCKTON COMPANIES, LLC4 | 1801 K STREET NW WASHINGTON, DC 20006 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $663 | $0 | $663 | 3.69% |
| AMBERLEY PARK ASSOCIATES INC.4 Filed as: AMBERLEY PRK ASSOCIATES INC. | 3605 SANDY PLAINS ROAD SUITES 240 AND 244 MARIETTA, GA 30066 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $401 | $0 | $401 | 2.23% |
| MERCER HEALTH AND BENEFITS, LLC4 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $283 | $0 | $283 | 1.57% |
| CHRISTIAN F. ROGNER4 | PO BOX 1318 LEWISBURG, WV 24901 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $161 | $0 | $161 | 0.90% |
| MJ INSURANCE4 Filed as: AGAR THOMAS AND VARIOUS AGENTS | 524 LEE STREET BURLINGTON, NC 27217 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $161 | $0 | $161 | 0.90% |
| HIGH POINT ALLIANCE4 | 1119 EAST BIRCHBROOK CIRCLE COTTONWOOD HEIGHTS, UT 84047 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $69 | $0 | $69 | 0.38% |
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 | 1,613 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 72 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,685 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 41 | $328K |
| Vision | VISION SERVICE PLAN | 1,306 | $230K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,754 | $974K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,754 | $700K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 41 | $328K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,754 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,754 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.