| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 70 LINDEN OAKS SUITE 210 ROCHESTER, NY 14625 | EXCELLUS BLUE CROSS BLUE SHIELD | $80K | — | $80K | 3.17% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS,LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $1K | $12K | 4.33% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 70 LINDEN OAKS SUITE 201 ROCHESTER, NY 14625 | EXCELLUS BLUE CROSS BLUE SHIELD | $10K | — | $10K | 4.22% |
| GREGORY L ULATOWSKI Filed as: GREGORY ULATOWSKI | 305 PLYMOUTH DRIVE SYRACUSE, NY 13206 | THE PAUL REVERE LIFE INSURANCE COMPANY | $3K | $295 | $3K | 10.63% |
| JEFFREY GREENBLOTT | 4232 EMERSON PLACE VESTAL, NY 13850 | THE PAUL REVERE LIFE INSURANCE COMPANY | $1K | $134 | $2K | 5.09% |
| HEATHER MARIE SODON | 17485 STATE RTE 167 MONTROSE, PA 18801 | THE PAUL REVERE LIFE INSURANCE COMPANY | $189 | $65 | $254 | 0.79% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS,LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60694 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $391 | $2K | 8.61% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS,LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60694 | STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK | $2K | — | $2K | 10.02% |
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 | 298 | 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) | 382 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | EXCELLUS BLUE CROSS BLUE SHIELD | 245 | $2.5M |
| Dental | EXCELLUS BLUE CROSS BLUE SHIELD | 251 | $237K |
| Vision | STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK | 328 | $23K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 430 | $286K |
| Short-term disability(2 contracts, 2 carriers) | THE PAUL REVERE LIFE INSURANCE COMPANY | 315 | $55K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 430 | $286K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 430 | $286K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 430 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.