| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $564 | $5K | — |
| ASSOCIATED FINANCIAL GROUP LLC3 | 711 EISENHOWER DR KIMBERLY, WI 54136 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $990 | $6K | — |
| CARUTH, JENNON, M3 | 16526 W 78TH ST STE 115 EDEN PRAIRIE, MN 55346 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $713 | — | $713 | — |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS MINNEAPOLI | 4565 PAYSHERE CIR CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $523 | $39 | $562 | — |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $407 | — | $407 | — |
| CARUTH, JENNON, M3 | 16526 W 78TH ST STE 115 EDEN PRAIRIE, MN 55346 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $891 | — | $891 | — |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS MINNEAPOLI | 4565 PAYSHERE CIR CHICAGO, IL 60674 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $84 | — | $84 | — |
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 | 257 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 33 | $0 |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 95 | $0 |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 25 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 95 | — |
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.