| 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 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $26K | — | $26K | 23.92% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | VISION SERVICE PLAN | $431 | — | $431 | 0.94% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $1K | — | $1K | 2.85% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 1050 CONNECTICUT AVE. NW STE 700 WASHINGTON, DC 20036 | ZURICH AMERICAN INSURANCE COMPANY | $551 | — | $551 | 31.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA EIN 54-0357120 CLAIMS ADMINISTRATION | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Claims processing; Float revenue; Other services Service code 12 | — | $186K |
| NETWORK ADMINISTRATORS DBA GSA EIN 11-3335620 ADMIN SUPPORT SERVICES | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general) Service code 15 | — | $80K |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 CLAIMS ADMINISTRATION | Claims processing; Contract Administrator Service code 12 | — | $15K |
| 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 | 359 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 6 | $35K |
| Dental | DELTA DENTAL OF VIRGINIA | 245 | $0 |
| Vision | VISION SERVICE PLAN | 224 | $46K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 359 | $109K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 359 | $109K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 359 | $109K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 199 | $78K |
| Other | ZURICH AMERICAN INSURANCE COMPANY | 352 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 359 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.