| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $91K | — | $91K | 6.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $33K | — | $33K | 4.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $11K | — | $11K | 4.00% |
| ANTHEM INSURANCE COMPANIES, INC.0 Filed as: ANTHEM INSURANCE COMPANIES | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 462044903 | FOUR EVER LIFE INS CO. | $750 | — | $750 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX, INC. EIN 33-0441200 PBM | Claims processing; Other fees; Float revenue; Direct payment from the plan Service code 12 | — | $13.3M |
| COMMUNITY INSURANCE COMPANY EIN 31-1440175 NONE | Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator Service code 12 | — | $5.2M |
| CVS PHARMACY, INC EIN 05-0340626 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Claims processing Service code 12 | — | $312K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 NONE | Claims processing; Contract Administrator Service code 12 | — | $239K |
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 | 11,455 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 110 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 11,565 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FOUR EVER LIFE INS CO. | 9,144 | $5K |
| Vision(2 contracts) | VISION SERVICE PLAN | 9,195 | $1.4M |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 17,725 | $2.3M |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,137 | $284K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 17,725 | — |
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.