| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH & BENEFITS, LLC | 155 N WACKER DR. SUITE 1500 CHICAGO, IL 606061710 | KAISER FOUNDATION HEALTH PLAN, INC. | $19K | — | $19K | 2.49% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH & BENEFITS, LLC | 155 N WACKER DR. SUITE 1500 CHICAGO, IL 606061710 | KAISER FOUNDATION HEALTH PLAN, INC. | $25K | — | $25K | 4.48% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS AND BLUE SHIELD OF MINN EIN 41-0984460 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $3.0M |
| SIMPLE EIN 45-5118723 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $130K |
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 | 4,942 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,949 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 150 | $1.3M |
| Vision | VISION SERVICE PLAN | 3,051 | $818K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,051 | — |
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.