| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRUDENTIAL - LIFE INSURANCE | $27K | — | $27K | 26.90% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | VISION SERVICE PLAN | $2K | — | $2K | 3.36% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVE OF THE AMERICAS 23RD FLOOR NEW YORK, NY 10036 | ACE AMERICAN INSURANCE COMPANY | $1K | — | $1K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 CLAIM ADMIN & RELATED SER | Contract Administrator; Float revenue; Direct payment from the plan; Non-monetary compensation; Other services; Named fiduciary; Claims processing; Participant communication Service code 12 | 900 COTTAGE GROVE ROAD BLOOMFIELD, CT 06002 | $281K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 ST DISABILITY ADVICE | Consulting (general) Service code 16 | 751 BROAD STREET NEWARK, NJ 07102 | $13K |
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 | 343 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 352 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF NJ, INC. | 359 | $341K |
| Vision | VISION SERVICE PLAN | 263 | $60K |
| Life insurance(7 contracts, 7 carriers) | PRUDENTIAL - LONG-TERM DISABILITY, TEMPORARY DISABILITY, LIFE INSUR | 416 | $454K |
| Short-term disability(5 contracts, 5 carriers) | PRUDENTIAL - LONG-TERM DISABILITY, TEMPORARY DISABILITY, LIFE INSUR | 950 | $200K |
| Long-term disability(2 contracts, 2 carriers) | PRUDENTIAL - LONG-TERM DISABILITY, TEMPORARY DISABILITY, LIFE INSUR | 411 | $228K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 950 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.