| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC7 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 0.27% |
| MERCER HEALTH AND BENEFITS, LLC7 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $187 | $5K | 20.72% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | METROPOLITAN LIFE INSURANCE COMPANY - BASIC LIFE/AD&D | — | $38 | $38 | 0.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VA, INC. EIN 54-0357120 ASO MED CLAIMS | Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $1.7M |
| DELTA DENTAL OF VIRGINIA EIN 54-0844477 ASO DENTAL CLAIMS | Contract Administrator Service code 13 | — | $108K |
| CVS PHARMACY, INC EIN 05-0340626 ASO RX CLAIMS | Direct payment from the plan; Float revenue; Other services; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $3K |
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 | 4,127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 56 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 4,183 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 3,255 | $612K |
| Dental | DELTA DENTAL OF VIRGINIA | 3,294 | $108K |
| Vision | VISION SERVICE PLAN | 2,807 | $579K |
| Life insurance(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,354 | $520K |
| Short-term disability | CIGNA LIFE INSURANCE CO. OF NEW YORK | 18 | $3K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,410 | $530K |
| Prescription drug | CVS PHARMACY, INC. | 3,255 | $3K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 3,255 | $612K |
| Other(6 contracts, 6 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 4,637 | $928K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,637 | — |
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.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.