| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | DELTA DENTAL OF INDIANA | $20K | — | $20K | 2.74% |
| RONALD M WEAVER3 | 7899 BAYMEADOWS WAY JACKSONVILLE, FL 32245 | AETNA LIFE INSURANCE COMPANY | $13K | — | $13K | 3.72% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH SALDANA | PO BOX 9023549 SAN JUAN, PR 009023549 | TRIPLE-S SALUD, INC. | $11K | — | $11K | 5.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNIFIED LIFE INSURANCE COMPANY | $1K | — | $1K | 0.75% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | METROPOLITAN LIFE INSURANCE COMPANY | $4K | $2K | $6K | 39.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $2.3M |
| NEWTORK PHARMACY MARGIN EIN 12-3456789 OTHER | Other fees Service code 99 | — | $19K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $0 |
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 | 2,004 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,015 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRIPLE-S SALUD, INC. | 38 | $400K |
| Dental(3 contracts, 3 carriers) | DELTA DENTAL OF INDIANA | 3,178 | $956K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 2,555 | $261K |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,736 | $561K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 1,736 | $342K |
| Prescription drug | TRIPLE-S SALUD, INC. | 38 | $219K |
| Other | AETNA LIFE INSURANCE COMPANY | 1,736 | $342K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,178 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.