| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIR CHICAGO, IL 60674 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 0.72% |
| GREG HINIRICHS3 | SOUTHPARK TOWERS SUITE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $6K | $12K | 14.42% |
| DANIEL WARD RICHARDSON3 Filed as: DANIEL RICHARDSON | 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | $415 | $7K | 7.63% |
| JAMES W DEUINK3 | SOUTHPARK TOWERS 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $6K | — | $6K | 7.15% |
| IVAN HINRICHS3 | 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $415 | $415 | 0.48% |
| AON CONSULTING INC3 Filed as: AON HEWITT | 3115 S WACKER DRIVE, STE 1550 CHICAGO, IL 60606 | MAGELLAN BEHAVIORAL HEALTH | — | $4K | $4K | 11.45% |
| GREG HINIRICHS3 | SOUTHPARK TOWERS SUITE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $787 | $742 | $2K | 13.52% |
| DANIEL WARD RICHARDSON3 Filed as: DANIEL RICHARDSON | 6000 FAIRVIEW RD,STE 400 CHARLOTTE, NC 28110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $764 | $57 | $821 | 7.26% |
| JAMES W DEUINK3 | SOUTHPARK TOWERS 6000 FAIRVIEW RD, STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $764 | — | $764 | 6.76% |
| IVAN HINRICHS3 | 6000 FAIRVIEW ROAD, STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $57 | $57 | 0.50% |
| GREG HINIRICHS3 | SOUTHPARK TOWERS 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $27 | $42 | $69 | 35.57% |
| DANIEL WARD RICHARDSON3 Filed as: DANIEL W RICHARDSON | 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 13.40% |
| JAMES W DEUINK3 | SOUTHPARK TOWERS 6000 FAIRVIEW ROAD STE 400 CHARLOTTE, NC 28210 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $26 | — | $26 | 13.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $1.3M |
| BENEFITS SCRIPTS EIN 37-1454096 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $191K |
| PLANTE MORAN EIN 38-1357951 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $85K |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $59K |
| CIGNA NONE | Insurance services; Direct payment from the plan Service code 23 | P.O. BOX 20643 LEHIGH VALLEY, PA 180020643 | $34K |
| INTERACTIVE HEALTH EIN 36-3798756 NONE | Direct payment from the plan; Insurance services Service code 23 | — | $13K |
| DELOITTE TAX LLP EIN 86-1065772 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $12K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $10K |
| PASSPORT HEALTH EIN 20-5572188 NONE | Insurance services; Direct payment from the plan Service code 23 | — | $9K |
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 | 1,560 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,560 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HMSA | 24 | $144K |
| Dental | HMSA | 24 | $144K |
| Vision | VISION SERVICE PLAN | 889 | $177K |
| Life insurance(3 contracts) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,910 | $854K |
| Long-term disability(4 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 918 | $345K |
| Other(3 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,910 | $855K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,910 | — |
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.