| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIEGO ADRIAN CONEJO3 | 14642 S. DENKER AVENUE GARDENA, CA 90247 | CALIFORNIA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CALIFORNIA | $74K | — | $74K | 4.20% |
| CLAREMONT BUSINESS GROUP3 Filed as: CLAREMONT BUSINESS GROUP, INC. | 1000 BURNETT AVENUE SUITE 330 CONCORD, CA 94520 | CALIFORNIA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CALIFORNIA | $37K | — | $37K | 2.12% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CALIFORNIA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CALIFORNIA | $7K | — | $7K | 0.39% |
| DIEGO ADRIAN CONEJO3 | 21221 S WESTERN AVENUE SUITE 110 TORRANCE, CA 905012972 | PRINCIPAL LIFE INSURANCE COMPANY | $8K | — | $8K | 9.12% |
| CENTERSTONE INSURANCE AND FINANCIAL3 | PO BOX 664173 DALLAS, TX 752664173 | PRINCIPAL LIFE INSURANCE COMPANY | — | $4K | $4K | 4.56% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 1560 SAWGRASS CORPORATE PARKWAY SUITE 240 SUNRISE, FL 333232852 | PRINCIPAL LIFE INSURANCE COMPANY | $778 | — | $778 | 0.90% |
| GIS BENEFITS INC3 Filed as: GIS BENEFITS INC. | 422 WAUPONSEE STREET MORRIS, IL 604502215 | PRINCIPAL LIFE INSURANCE COMPANY | — | $373 | $373 | 0.43% |
| DIEGO ADRIAN CONEJO3 | 2100 REDONDO BEACH BLVD. SUITE C413 TORRANCE, CA 90504 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 16.93% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 4.07% |
| DIEGO ADRIAN CONEJO3 | 2100 REDONDO BEACH BLVD. SUITE C413 TORRANCE, CA 90504 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 16.23% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $465 | — | $465 | 4.77% |
| DIEGO ADRIAN CONEJO3 | 2100 REDONDO BEACH BLVD. SUITE C413 TORRANCE, CA 90504 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $3K | $4K | 54.60% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $354 | — | $354 | 4.49% |
| DIEGO ADRIAN CONEJO3 | 2100 REDONDO BEACH BLVD. SUITE C413 TORRANCE, CA 90504 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $2K | $3K | 44.28% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $254 | — | $254 | 3.39% |
| DIEGO ADRIAN CONEJO3 | 2100 REDONDO BEACH BLVD. SUITE C413 TORRANCE, CA 90504 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 16.75% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS, LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $308 | — | $308 | 4.24% |
No Schedule C service providers reported on this filing.
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 | 164 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CALIFORNIA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CALIFORNIA | 215 | $1.7M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 252 | $86K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 252 | $86K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 89 | $10K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 48 | $30K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CALIFORNIA | 215 | $1.7M |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 89 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 252 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.