| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $22K | $22K | 1.76% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | SYMETRA LIFE INSURANCE | — | $7K | $7K | 1.17% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS, INC. | 897 12TH STREET HAMMONTON, NJ 08037 | AMERICAN HERITAGE LIFE | $90K | — | $90K | 25.18% |
| DANIEL COBB3 | 266 MCLAREN GATE DR MARIETTA, GA 30060 | AMERICAN HERITAGE LIFE | $872 | — | $872 | 0.24% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | HARTFORD LIFE AND ACCIDENT | — | $1K | $1K | 0.76% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $23K | — | $23K | 25.31% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS - ATL | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $995 | $13K | 16.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $1.5M |
| PAYFLEX SYSTEMS USA INC CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 10802 FARNAM DRIVE, STE 100 OMAHA, NE 68154 | $113K |
| EXPRESS SCRIPTS EIN 43-1420563 CLAIMS PROCESSING | Contract Administrator Service code 13 | 525 WEST MONROE STREET CHICAGO, IL 60661 | $89K |
| CERIDIAN CORPORATION EIN 81-1114266 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 3311 E. OLD SHAKOPEE ROAD MINNEAPOLIS, MN 55425 | $25K |
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 | 2,353 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 43 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,396 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE | 514 | $421K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 5,400 | $2.7M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 2,080 | $422K |
| Life insurance(2 contracts) | MINNESOTA LIFE INSURANCE COMPANY | 5,636 | $1.4M |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 5,400 | $3.9M |
| Long-term disability(2 contracts, 2 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 3,134 | $1.4M |
| Prescription drug | HMSA | 6 | $64K |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE | 2,248 | $617K |
| Other(3 contracts, 3 carriers) | HARTFORD LIFE AND ACCIDENT | 3,134 | $246K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,636 | — |
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.