| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH BENEFITS | 113 WEST HUBBARD STREET CHICAGO, IL 60654 | CIGNA | $35K | — | $35K | 3.40% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGOHAN BRABENDER, INC. | 3931 SOUTH DIXIE DRIVE DAYTON, OH 45439 | CIGNA | $21K | — | $21K | 2.09% |
| HAVENS & COMPANY INC3 Filed as: HAVENS AND COMPANY, INC. | PO BOX 1267 GLOUCESTER, MA 01931 | HARTFORD LIFE AND ACCIDENT | $32K | — | $32K | 5.00% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MCGOHAN BRABENDER, INC. | 3931 SOUTH DIXIE DRIVE DAYTON, OH 45439 | EYEMED | $2K | — | $2K | 2.00% |
| HAVENSURE AND COMPANY, INC.3 | PO BOX 1267 GLOUCESTER, MA 01930 | HARTFORD LIFE AND ACCIDENT | $6K | — | $6K | 15.00% |
| HAVENS & COMPANY INC3 Filed as: HAVENS & CO. INC. | POST OFFICE BOX 1267 GLOUCESTER, MA 01931 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 5.24% |
| THE GLATFELTER AGENCY INC.3 Filed as: GLATFELTER AGENCY | 221 WEST PHILADELPHIA STREET YORK, PA 17404 | SUN LIFE | $721 | — | $721 | 10.67% |
| HAVENS & COMPANY INC3 Filed as: HAVENS AND COMPANY, INC. | 3 FRONT STREET, LOWER MILL, STE 321 ROLLINSFORD, NH 03869 | GERBER LIFE INSURANCE COMPANY | $686 | — | $686 | 15.01% |
| THE GLATFELTER AGENCY INC.3 Filed as: GLATFELTER AGENCY, INC. | 231 WEST PHILADELPHIA YORK, PA 17404 | SUN LIFE | $231 | — | $231 | 12.02% |
| THE GLATFELTER AGENCY INC.3 Filed as: GLATFELTER AGENCY, INC. | 221 WEST PHILADELPHIA STREET YORK, PA 17404 | SUN LIFE | $132 | — | $132 | 12.02% |
| THE GLATFELTER AGENCY INC.3 Filed as: GLATFELTER AGENCY, INC. | 221 WEST PHILADELPHIA STREET YORK, PA 17404 | SUN LIFE | $25 | — | $25 | 11.90% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA EIN 59-1031071 NONE | Participant communication; Named fiduciary; Claims processing; Float revenue; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Other services Service code 12 | — | $599K |
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 | 1,291 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,300 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF OHIO | 2,453 | $777K |
| Vision | EYEMED | 2,114 | $110K |
| Life insurance(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,240 | $638K |
| Short-term disability(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 70 | $38K |
| Long-term disability(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,240 | $639K |
| Stop-loss / reinsurancereinsurance | CIGNA | 2,514 | $1.0M |
| Other(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,291 | $677K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,514 | — |
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.