| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE, INC. | PO BOX 259408 MADISON, WI 53725 | DEAN HEALTH PLAN INC. | $30K | — | $30K | 1.43% |
| MERCER HEALTH AND BENEFITS, LLC3 | 70 LINDEN OAKS SUITE 210 ROCHESTER, NY 14625 | EXCELLUS BLUE CROSS BLUE SHIELD | $64K | — | $64K | 3.54% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $8K | — | $8K | 5.76% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $4K | — | $4K | 5.16% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $5K | — | $5K | 7.59% |
| SELECT NETWORKS3 | 317 6TH AVENUE DES MOINES, IA 50309 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $7K | — | $7K | 21.00% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN JOHNSON INSURANCE INC. | PO BOX 259408 MADISON, WI 53725 | AMERITAS LIFE INSURANCE CORP. | $2K | $33 | $2K | 6.92% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | FOREST T. JONES / STANDARD SECURITY LIFE INS COMPANY OF NEW YORK | $2K | — | $2K | 10.06% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA LIFE INSURANCE CO. OF NEW YORK | $909 | — | $909 | 5.76% |
| M3 INSURANCE SOLUTIONS INC3 Filed as: M3 INSURANCE SOLUTIONS, INC. | 3113 WEST BELTLINE HWY MADISON, WI 53713 | FEDERAL INSURANCE COMPANY | $525 | $140 | $665 | 19.00% |
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 | 730 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 36 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 766 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | DEAN HEALTH PLAN INC. | 536 | $5.7M |
| Vision(4 contracts, 4 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 578 | $1.9M |
| Life insurance | CIGNA LIFE INSURANCE CO. OF NEW YORK | 730 | $146K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 730 | $87K |
| Long-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 730 | $69K |
| Prescription drug(3 contracts, 2 carriers) | EXCELLUS BLUE CROSS BLUE SHIELD | 192 | $3.6M |
| Other(2 contracts, 2 carriers) | CIGNA LIFE INSURANCE CO. OF NEW YORK | 730 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 730 | — |
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.