| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 27647 NETWORK PLACE CHICAGO, IL 60673 | ANTHEM HEALTH PLANS OF MAINE, INC. | $114K | — | $114K | 1.74% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $735 | $4K | 2.82% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $24K | $736 | $24K | 16.57% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $677 | $3K | 2.50% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | VISION SERVICE PLAN | $2K | — | $2K | 3.76% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $126 | $3K | 9.99% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $77 | $3K | 16.75% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $33 | $1K | 16.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL PLAN OF MAINE EIN 01-0286541 DENTAL CLAIMS PROCESSING | Claims processing Service code 12 | ONE DELTA DRIVE CONCORD, NH 03302 | $55K |
| MERCER HEALTH & BENEFITS LLC EIN 34-2015463 BROKER | Insurance agents and brokers Service code 22 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | $10K |
| COMBINED SERVICES LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | DBA CSONE BENEFIT SOLUTIONS 2 DELTA DRIVE SUITE 301 CONCORD, NH 03301 | $232 |
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 | 622 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 84 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 706 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF MAINE, INC. | 1,048 | $6.6M |
| Vision(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF MAINE, INC. | 1,048 | $6.6M |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 641 | $172K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 600 | $138K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 600 | $150K |
| Other(3 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF MAINE, INC. | 1,048 | $6.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,048 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.