| 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 | $4K | $293 | $4K | 0.37% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $176 | $2K | 0.21% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $106 | $2K | 0.18% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $93 | $0 | $93 | 0.01% |
| LOCKTON COMPANIES, LLC3 | PO BOX 415840 BOSTON, MA 02241 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17 | $0 | $17 | 0.00% |
| LOCKTON COMPANIES, LLC3 | 3 EMBARCADERO CENTER, SUITE 609 SAN FRANCISCO, CA 94111 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $310 | $5K | 19.35% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $194 | $3K | 10.71% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $105 | $3K | 9.71% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $101 | $1 | $102 | 0.39% |
| LOCKTON COMPANIES, LLC3 | PO BOX 843844 KANSAS CITY, MO 64184 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $0 | $60 | 0.23% |
| BCINSOURCING, LLC3 | 6363 COLLEGE BOULEVARD, SUITE 500 OVERLAND PARK, KS 66211 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $60 | $0 | $60 | 0.23% |
| LOCKTON COMPANIES, LLC3 | PO BOX 415840 BOSTON, MA 02241 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $24 | $0 | $24 | 0.09% |
| MARY THERESA FISHER4 | 29C OWENS LANDING COURT PERRYVILLE, MD 21903 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | $0 | $2K | 10.19% |
| LOCKTON COMPANIES, LLC4 | 1801 K STREET NW WASHINGTON, DC 20006 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $2K | $0 | $2K | 7.43% |
| AMBERLEY PARK ASSOCIATES INC.4 Filed as: AMBERLEY PARK ASSOCIATION INC. | 3605 SANDY PLAINS ROAD SUITE 240 244 MARIETTA, GA 30066 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $320 | $0 | $320 | 1.53% |
| MERCER HEALTH AND BENEFITS, LLC4 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $227 | $0 | $227 | 1.09% |
| CHRISTIAN F. ROGNER4 | PO BOX 1318 LEWISBURG, WV 24901 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $154 | $0 | $154 | 0.74% |
| HIGH POINT ALLIANCE4 | 1119 EAST BIRCHBROOK CIRCLE COTTONWOOD HEIGHTS, UT 84047 | PRE-PAID LEGAL SERVICES, INC. DBA LEGAL SHIELD | $57 | $0 | $57 | 0.27% |
| LOCKTON COMPANIES, LLC3 | 3 EMBARCADERO CENTER, SUITE 609 SAN FRANCISCO, CA 94111 | FIRST UNUM LIFE INSURANCE COMPANY | $1K | $0 | $1K | 52.16% |
| JAMES H. VAN EPPS3 | 10930 CRABAPPLE ROAD, SUITE 206 ROSWELL, GA 30075 | FIRST UNUM LIFE INSURANCE COMPANY | $554 | $0 | $554 | 26.06% |
| CHARLES D. BLOCK3 | 648 VILLAGE PARK DRIVE, UNIT 208 WILMINGTON, NC 28405 | FIRST UNUM LIFE INSURANCE COMPANY | $554 | $0 | $554 | 26.06% |
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 | 1,362 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 56 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,418 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 1,137 | $196K |
| Life insurance(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,420 | $1.1M |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,420 | $1.0M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,420 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,420 | — |
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."
No prospect flags tripped on this filing.