| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $279 | $279 | 0.02% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE STE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $44 | $44 | 0.00% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | AETNA LIFE INSURANCE COMPANY | $17K | — | $17K | 8.50% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | AETNA INTERNATIONAL | $8K | — | $8K | 9.09% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $123 | $2K | 8.33% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVE, STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $270 | $8 | $278 | 1.20% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 N FIRST ST SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $208 | — | $208 | 0.90% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | $101 | $1K | 7.75% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVE, STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $91 | — | $91 | 0.56% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES | 738 N FIRST ST SAN JOSE, CA 95112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $42 | — | $42 | 0.26% |
No Schedule C service providers reported on this filing.
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 | 1,617 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,625 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 486 | $3.6M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 9 | $287K |
| Vision(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 9 | $287K |
| Life insurance(5 contracts, 5 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,615 | $1.8M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,615 | $1.5M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,615 | $1.5M |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 486 | $3.4M |
| Other(5 contracts, 5 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,617 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,617 | — |
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.