| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | SUN LIFE ASSURANCE COMPANY OF CANADA | $16K | $8K | $24K | 2.34% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS ADMIN | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $2K | $4K | 0.41% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS ADMIN | GPO BOX 27447 CORPORATE LOCKBOX NEW YORK, NY 10087 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $0 | $42K | $42K | 30.09% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INSURANCE SVCS | 700 WEST 47TH STREET SUITE 1100 KANSAS CITY, MO 64112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11K | $1K | $13K | 9.02% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH SALDANA | PO BOX 9023549 SAN JUAN, PR 00902 | TRIPLE S SALUD, INC | $6K | $0 | $6K | 5.00% |
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 | 3,031 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 37 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,068 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 40 | $553K |
| Dental | TRIPLE S SALUD, INC | 14 | $111K |
| Vision | VISION SERVICE PLAN | 1,784 | $237K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,148 | $1.0M |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,148 | $1.0M |
| Prescription drug(3 contracts, 3 carriers) | HAWAII MEDICAL SERVICE ASSOCIATION | 40 | $553K |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 3,148 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,148 | — |
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."
No prospect flags tripped on this filing.