| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 0.72% |
| CUSTOM BENEFIT PROGRAMS INC3 | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $0 | $3K | 3.87% |
| BUSINESS INSURANCE AGENCY3 Filed as: BUSINESS INSURANCE AGENCY INC | PO BOX 469 AUGUSTA, ME 04332 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $759 | $0 | $759 | 0.87% |
| WILLIS TOWERS WATSON US LLC3 Filed as: THE DUNLAP CORPORATION AKA WILLIS-H | PO BOX 469 AUGUSTA, ME 04332 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $492 | $0 | $492 | 0.57% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENFITS | TWO MONUMENT SQ PORTLAND, ME 04104 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $110 | $0 | $110 | 0.13% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $612 | $0 | $612 | 0.71% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $521 | $0 | $521 | 0.72% |
| LEBEL & HARRIMAN3 | 366 US ROUTE ONE FALMOUTH, ME 04105 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $347 | $0 | $347 | 1.25% |
| LEBEL & HARRIMAN3 | 366 US ROUTE ONE FALMOUTH, ME 04105 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $337 | $0 | $337 | 31.97% |
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 | 1,493 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,510 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,493 | $701K |
| Short-term disability(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 255 | $116K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 569 | $86K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,493 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,493 | — |
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.