| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $698 | — | $698 | 3.97% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $115 | $115 | 0.65% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INS SERVICES INC | 32 OLD SLIP NEW YORK, NY 10005 | TRANSAMERICA LIFE INSURANCE COMPANY | $2K | — | $2K | 37.45% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4 EMBARCADERO CTR, SUITE 40 SAN FRANSISCO, CA 94111 | TRANSAMERICA LIFE INSURANCE COMPANY | $233 | — | $233 | 3.63% |
| CRYSTAL IBC LLC3 | 32 OLD SLIP NEW YORK, NY 10005 | HYATT LEGAL PLANS | $38 | $12 | $50 | 13.02% |
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 | 174 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 179 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 430 | $191K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 161 | $18K |
| Vision | FIDELITY SECURITY LIFE INSURANCE COMPANY | 335 | $2K |
| Life insurance(4 contracts, 2 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 218 | $12K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 219 | $0 |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 104 | $0 |
| Other(3 contracts, 3 carriers) | TRANSAMERICA LIFE INSURANCE COMPANY | 467 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 467 | — |
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.