| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 Filed as: AON CONSULTING | 99 HIGH ST. BOSTON, MA 02110 | SANFORD HEALTH PLAN | $3K | $0 | $3K | 1.76% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $1K | $3K | 2.80% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH & BENEFITS LLC | 155 N. WACKER DRIVE STE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC | — | — | $0 | 0.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | ANTHEM HEALTH PLANS OF VIRGINIA | $2K | $0 | $2K | 4.18% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 155 N. WACKER DRIVE STE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC | $458 | $0 | $458 | 1.51% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 155 N. WACKER DRIVE STE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $393 | $0 | $393 | 1.86% |
| BENEFIT PLAN SOLUTIONS, INC.3 Filed as: BENEFIT PLAN SOLUTIONS | 680 IWILEI RD STE 520 HONOLULU, HI 96817 | HAWAII DENTAL SERVICE | $184 | $0 | $184 | 2.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $7 | $7 | 0.13% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 500 W MONROE ST STE 3400 CHICAGO, IL 60661 | METROPOLITAN LIFE INSURANCE COMPANY | $79 | $20 | $99 | — |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | METROPOLITAN LIFE INSURANCE COMPANY | $49 | $14 | $63 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA INC EIN 54-0357120 CLAIMS ADMINISTRATOR | Float revenue; Other services; Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $296K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CLAIMS ADMINISTRATOR | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Contract Administrator; Other services Service code 12 | — | $30K |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | SANFORD HEALTH PLAN | 0 | $416K |
| Dental | HAWAII DENTAL SERVICE | 0 | $9K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA | 0 | $54K |
| Life insurance(3 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPANY | 0 | $235K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 0 | $108K |
| Prescription drug | BLUE CROSS BLUE SHIELD | 0 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.