| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 27647 NETWORK PLACE CHICAGO, IL 60673 | ANTHEM HEALTH PLANS OF VIRGINIA INC. | — | $5K | $5K | 0.51% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A. SCOTT & SON, INC. | P.O. BOX 603438 CHARLOTTE, NC 282603438 | VISION SERVICE PLAN (VSP) | $8K | — | $8K | 8.34% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | VISION SERVICE PLAN (VSP) | $3K | — | $3K | 3.35% |
| JAMES A SCOTT & SON INC3 Filed as: JAMES A. SCOTT & SONS INC. | 1301 OLD GRAVES MILL RD LYNCHBURG, VA 245024317 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $16K | $0 | $16K | 45.67% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 606740001 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $8K | $0 | $8K | 22.92% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $6K | $0 | $6K | 16.92% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $0 | $219 | $219 | 0.62% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA INC EIN 54-0357120 BENEFIT ADMINISTRATOR | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $551K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 THIRD PARTY ADMIN | Contract Administrator Service code 13 | P.O. BOX 7827 PHILADELPHIA, PA 19176 | $37K |
| PRUDENTIAL INSURANCE COMPANY EIN 22-1211670 THIRD PARTY ADMIN | Contract Administrator Service code 13 | P.O. BOX 7827 PHILADELPHIA, PA 19176 | $23K |
| COMPSYCH EIN 35-3739783 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $12K |
| JAMES A. SCOTT & SON INC. BROKER | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 813 NORTHSHORE DR. STE 101 KNOXVILLE, TN 37919 | $0 |
| MERCER HEALTH & BENEFITS LLC EIN 34-2015463 THIRD PARTY ADMIN | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 4565 PAYSCHERE CIRCLE CHICAGO, IL 60674 | $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 | 1,135 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA INC. | 1,974 | $966K |
| Vision(2 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA INC. | 1,974 | $1.1M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,135 | $35K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 1,091 | $249K |
| Prescription drug | ANTHEM HEALTH PLANS OF VIRGINIA INC. | 1,974 | $966K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA INC. | 1,974 | $966K |
| Other(5 contracts, 2 carriers) | ANTHEM HEALTH PLANS OF VIRGINIA INC. | 1,974 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,974 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.