| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSHPERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $23K | $23K | 1.87% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSHPERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $29K | $10K | $38K | 7.44% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSHPERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $8K | — | $8K | 9.97% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSHPERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $2K | $2K | 3.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BLUECROSS BLUESHIELD EIN 15-0329043 | Claims processing Service code 12 | 165 COURT STREET ROCHESTER, NY 14647 | $813K |
| PREVENTURE, LLC. EIN 05-0466481 | Other fees; Consulting fees Service code 70 | 2000 NOOSENECK HILL ROAD COVENTRY, RI 02816 | $286K |
| HB SOLUTIONS LLC EIN 75-3230062 | Other fees Service code 99 | 99 GARNSEY ROAD PITTSFORD, NY 14534 | $140K |
| THE JELLY VISION LAB, INC. EIN 36-4442819 | Other fees Service code 99 | 848 W. EASTMAN STREET, SUITE 104 CHICAGO, IL 60642 | $126K |
| CASTLIGHT HEALTH, INC. EIN 26-1989091 | Other fees Service code 99 | TWO RINCON CENTER 121 SPEAR STREET, SAN FRANCISCO, CA 94105 | $124K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 | Claims processing Service code 12 | ONE EXPRESS WAY ST. LOUIS, MO 63121 | $111K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $98K |
| CALM & SENSE COMMUNICATIONS, LTD. EIN 86-1139927 | Other fees Service code 99 | 25 N. WASHINGTON ST. 4TH FLOOR ROCHESTER, NY 14614 | $73K |
| DISCOVERY BENEFITS | Other fees Service code 99 | 4321 20TH AVE SW FARGO, ND 58103 | $71K |
| CONNECT YOUR CARE EIN 26-1274092 | Other fees Service code 99 | 307 INTERNATIONAL CIR 200 HUNT VALLEY, MD 21030 | $52K |
| HEALTH ADVOCATE, INC. EIN 23-3080019 | Other fees Service code 99 | 3043 WALTON ROAD PLYMOUTH MEETING, PA 19462 | $44K |
| VISION SERVICE PLAN EIN 22-2777159 | Claims processing Service code 12 | P.O. BOX 45223 SAN FRANCISCO, CA 94145 | $27K |
| ADP, INC. EIN 13-3036745 | Contract Administrator Service code 13 | 2575 WESTSIDE PARKWAY SUITE 500 APLHARETTA, GA 30004 | $15K |
| SELBY MARKETING ASSOCIATES, INC. EIN 16-1329552 | Other fees Service code 99 | 1387 FAIRPORT RD., SUITE 800 FAIRPORT, NY 14450 | $11K |
| BANK OF AMERICA, N.A EIN 94-1687665 | Trustee (bank, trust company, or similar financial institution) Service code 21 | 100 NORTH TRYON STREET CHARLOTTE, NC 28255 | $10K |
| WAGEWORKS EIN 94-3351864 | Other fees; Consulting fees Service code 70 | 1100 PARK PLACE, 4TH FLOOR SAN MATEO, CA 94403 | $7K |
| HEWITT ASSOCIATES LLC EIN 36-2235791 | Other fees Service code 99 | 100 HALF DAY ROAD LINCONSHIRE, IL 60069 | $5K |
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 | 3,160 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE COMPANY | 495 | $109K |
| Life insurance | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 3,198 | $1.3M |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 2,342 | $45K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 3,130 | $513K |
| Stop-loss / reinsurancereinsurance | EXCELLUS BLUECROSS BLUESHIELD PLAN | 2,124 | $587K |
| Other(4 contracts, 3 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 3,407 | $340K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,407 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
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.