| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BUCK CONSULTANTS LLC3 | DEPT CH 14061 PALATINE, IL 60055 | HARTFORD LIFE AND ACCIDENT | $0 | — | $0 | 0.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1166 AVENUE OF THE AMERICAS NEW YORK, NY 10036 | FEDERAL INSURANCE COMPANY | $3K | — | $3K | 25.00% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | ALLSTATE | $336 | — | $336 | 3.04% |
| THOMAS C SMITH | 2928 FOSTER CREIGHTON DR NASHVILLE, TN 37204 | ALLSTATE | $317 | — | $317 | 2.87% |
| AMERICAN INS AGENCIES LLC | 18102 CHESTERFIELD AIRPORT RD STE E CHESTERFIELD, MO 63005 | ALLSTATE | $268 | — | $268 | 2.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHY ALLIANCE LIFE INSURANCE CO EIN 86-0257201 | Claims processing; Contract Administrator; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | — | $670K |
| BUCK CONSULTANTS LLC | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 200 GALLERIA PARKWAY ATLANTA, GA 30339 | $78K |
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 | 292 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 297 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTHY ALLIANCE LIFE INSURANCE COMPANY | 176 | $797K |
| Vision | NATIONAL GUARDIAN LIFE | 155 | $23K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 297 | $132K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 297 | $132K |
| Stop-loss / reinsurancereinsurance | HEALTHY ALLIANCE LIFE INSURANCE COMPANY | 176 | $786K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 303 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 303 | — |
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.