| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 27647 NETWORK PLACE CHICAGO, IL 60673 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $36K | — | $36K | 0.63% |
| SBP, LLC5 | 13 WHITE FIELD CT AMBLER, PA 19002 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $31K | $31K | 23.74% |
| ADP INC5 Filed as: AUTOMATIC DATA PROCESSING INC | PO BOX 842875 BOSTON, MA 02284 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $25K | $25K | 45.54% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 1150 MORAGA WAY MORAGA, CA 94556 | METROPOLITAN GENERAL INSURANCE COMPANY | $2K | $57 | $2K | 11.31% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 16.62% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 16.40% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 910 E HAMILTON AVE STE 410 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 16.40% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | MUTUAL OF OMAHA INSURANCE COMPANY | $575 | — | $575 | 6.10% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | MUTUAL OF OMAHA INSURANCE COMPANY | $368 | — | $368 | 3.90% |
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 | 788 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 793 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,160 | $5.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,160 | $5.7M |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,160 | $5.7M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 788 | $122K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 805 | $140K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 829 | $149K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,160 | $5.7M |
| Other(6 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 788 | $126K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,160 | — |
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.