| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC Filed as: AON CONSULTING | 99 HIGH ST. BOSTON, MA 02110 | SANFORD HEALTH PLAN | $17K | — | $17K | 1.72% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | METROPOLITAN LIFE INSURANCE COMPANY | — | $38 | $38 | 0.01% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | METROPOLITAN LIFE INSURANCE COMPANY | — | $16 | $16 | 0.00% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 525 W MONROE ST STE 600 CHICAGO, IL 606613640 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $8K | — | $8K | 10.00% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 525 W MONROE ST STE 600 CHICAGO, IL 606613640 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 10.00% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 525 W MONROE ST STE 600 CHICAGO, IL 606613640 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | METROPOLITAN LIFE INSURANCE COMPANY | — | $38 | $38 | 0.12% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 525 W MONROE ST STE 600 CHICAGO, IL 606613640 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.89% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 500 W MONROE ST STE 3400 CHICAGO, IL 606613778 | METROPOLITAL LIFE INSURANCE COMPANY | $607 | $43 | $650 | 9.70% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W 47TJ ST STE 900 ATTN TELLYE H KANSAS CITY, MO 641121906 | METROPOLITAL LIFE INSURANCE COMPANY | $0 | $105 | $105 | 1.57% |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 525 W MONROE ST STE 600 CHICAGO, IL 606613640 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $632 | — | $632 | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | METROPOLITAL LIFE INSURANCE COMPANY | — | $38 | $38 | 13.15% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | METROPOLITAL LIFE INSURANCE COMPANY | — | $38 | $38 | 13.77% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | HYATT LEGAL PLANS | $0 | $38 | $38 | — |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 500 W MONROE ST STE 3400 CHICAGO, IL 60661 | METROPOLITAL LIFE INSURANCE COMPANY | $3K | $43 | $3K | — |
| LOCKTON COMPANIES, LLC3 Filed as: LOCKTON COMPANIES LLC | 444 W 47TJ ST STE 900 ATTN TELLYE H KANSAS CITY, MO 64112 | METROPOLITAL LIFE INSURANCE COMPANY | — | $1K | $1K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA INC EIN 54-0357120 CLAIMS ADMINISTRATION | Contract Administrator; Other services; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $1.8M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 DISABILITY ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $170K |
| CIGNA BEHAVIORAL HEALTH INC. EIN 41-1648670 EMPLOYEE ASSISTANCE PROGR | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication Service code 12 | — | $0 |
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 CLAIMS ADMINISTRATION | Participant communication; Claims processing; Contract Administrator; Other services; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Float revenue Service code 12 | — | $0 |
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 | 3,936 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 3,936 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | SANFORD HEALTH PLAN | 206 | $2.2M |
| Dental(4 contracts, 3 carriers) | HAWAII DENTAL SERVICE | 3,939 | $66K |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA | 2,774 | $157K |
| Life insurance(3 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA | 3,547 | $1.1M |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 362 | $20K |
| Long-term disability(5 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 2,574 | $555K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 526 | $82K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,939 | — |
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.