| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 3 EMBARCADERO CENTER, SUITE 609 SAN FRANCISCO, CA 94111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $533 | $6K | 0.53% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $321 | $3K | 0.30% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $135 | $3K | 0.26% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $121 | $0 | $121 | 0.01% |
| LOCKTON COMPANIES, LLC3 | PO BOX 415840 BOSTON, MA 02241 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $98 | $0 | $98 | 0.01% |
| LOCKTON COMPANIES, LLC3 | 3 EMBARCADERO CENTER, SUITE 609 SAN FRANCISCO, CA 94111 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4K | $243 | $4K | 15.68% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE UNIT 208 WILMINGTON, MO 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $145 | $2K | 8.57% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $61 | $2K | 7.86% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $64 | $90 | $154 | 0.63% |
| LOCKTON COMPANIES, LLC3 | PO BOX 843844 KANSAS CITY, MO 64184 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | $0 | $90 | 0.37% |
| BCINSOURCING, LLC3 | 6363 COLLEGE BOULEVARD, SUITE 500 OVERLAND PARK, KS 66211 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $90 | $0 | $90 | 0.37% |
| LOCKTON COMPANIES, LLC3 | PO BOX 415840 BOSTON, MA 02241 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $31 | $0 | $31 | 0.13% |
| MARY THERESA FISHER3 | 26C OWENS LANDING COURT PERRYVILLE, MD 21903 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $964 | $0 | $964 | 6.35% |
| LOCKTON COMPANIES, LLC3 | 1801 K STREET NW WASHINGTON, DC 20006 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $662 | $0 | $662 | 4.36% |
| AMBERLEY PARK ASSOCIATES INC.3 | 3605 SANDY PLAINS ROAD SUITE 240 244 MARIETTA, GA 30066 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $343 | $0 | $343 | 2.26% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $223 | $0 | $223 | 1.47% |
| CHRISTIAN F. ROGNER3 | PO BOX 1318 LEWISBURG, WV 24901 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $147 | $0 | $147 | 0.97% |
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 | 1,532 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 68 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,600 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 40 | $242K |
| Vision | VISION SERVICE PLAN | 1,178 | $212K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 512 | $1.2M |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 512 | $1.2M |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 40 | $242K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 512 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,178 | — |
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.