| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $232K | — | $232K | 4.50% |
| HARVARD PRINTING GROUP5 | 175 US HIGHWAY 46 WEST FAIRFIELD, NJ 07004 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $19K | $19K | 0.37% |
| AXA ASSISTANCE, USA5 | 122 S MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $6K | $6K | 0.11% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4400 BANK ONE CENTER 1717 MAIN ST DALLAS, TX 75201 | UNITEDHEALTHCARE INSURANCE COMPANY | $42K | — | $42K | 4.32% |
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 | 4,850 | 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) | 4,850 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 324 | $8.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 324 | $879K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 3,432 | $964K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 4,850 | $5.1M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 4,850 | $5.1M |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 85 | $7.5M |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 4,850 | $5.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,850 | — |
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."
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.