| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | DELTA DENTAL OF INDIANA | $27K | — | $27K | 3.70% |
| RONALD M WEAVER3 | 7899 BAYMEADOWS WAY JACKSONVILLE, FL 32245 | AETNA LIFE INSURANCE COMPANY | $14K | — | $14K | 3.91% |
| 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 | 0.67% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $2.6M |
| NEWTORK PHARMACY MARGIN EIN 35-0781558 OTHER | Other fees Service code 99 | — | $10K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue; Claims processing 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 | 1,906 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,922 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | TRIPLE-S SALUD, INC. | 38 | $406K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF INDIANA | 3,240 | $936K |
| Vision | ANTHEM INSURANCE COMPANIES, INC. | 2,694 | $224K |
| Life insurance(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 1,777 | $561K |
| Long-term disability | AETNA LIFE INSURANCE COMPANY | 1,777 | $348K |
| Prescription drug | TRIPLE-S SALUD, INC. | 38 | $213K |
| Other | AETNA LIFE INSURANCE COMPANY | 1,777 | $348K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,240 | — |
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."
No prospect flags tripped on this filing.