| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES NATIONAL LLC | PO BOX 601478 CHARLOTTE, NE 282601478 | STANDARD INSURANCE COMPANY | $59K | $21K | $80K | 2.50% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH EXECUTIVE BENEFITS INC. | CORPORATE LOCK BOX GPO 27447 NEW YORK, NY 100877394 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $20K | — | $20K | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $41 | $41 | 0.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICE, INC. EIN 36-2739571 NONE | Insurance agents and brokers; Other services Service code 22 | — | $123K |
| US BANK EIN 36-2739571 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $5K |
| VISION SERVICE PLAN EIN 94-1632821 NONE | Other services; Claims processing Service code 12 | — | $2K |
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 | 5,310 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 897 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 965 | $4.8M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 9 | $129K |
| Life insurance | STANDARD INSURANCE COMPANY | 6,219 | $3.2M |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 965 | $4.8M |
| Other(4 contracts, 4 carriers) | STANDARD INSURANCE COMPANY | 6,219 | $3.6M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,219 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.