| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 3.99% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $724 | — | $724 | 1.52% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | VISION SERVICE PLAN | $4K | — | $4K | 10.01% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | — | $1K | 4.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $403 | — | $403 | 4.00% |
| RUEBEN WARNER ASSOCIATES, INC.3 | 1655 RICHMOND AVE. STATEN ISLAND, NY 10314 | ZURICH AMERICAN INSURANCE COMPANY | — | $289 | $289 | 19.93% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH | 2405 GRAND BLVD. STE 900 KANSAS CITY, MO 64108 | ZURICH AMERICAN INSURANCE COMPANY | $72 | — | $72 | 4.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| NETWORK ADMINISTRATORS DBA GSA EIN 11-3335620 ADMIN SUPPORT SERVICES | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Consulting (general) Service code 15 | — | $83K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $69K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 CLAIMS ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $12K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 CLAIMS ADMINISTRATION | Claims processing Service code 12 | — | $6K |
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 | 316 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 317 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 4 | $48K |
| Vision | VISION SERVICE PLAN | 188 | $38K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 273 | $10K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 273 | $98K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 273 | $26K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 145 | $66K |
| Other | ZURICH AMERICAN INSURANCE COMPANY | 273 | $1K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 273 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.