| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELWARE IN | 71 S WACKER DRIVE CHICAGO, IL 60606 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $4K | $4K | 0.62% |
| MERCER HEALTH AND BENEFITS, LLC Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIR CHICAGO, IL 606740001 | VISION SERVICE PLAN | $0 | — | $0 | 0.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS LLC | FOUR EMBARCADERO CENTER SUITE 400 SAN FRANCISCO, CA 94111 | HCC LIFE INSURANCE COMPANY | $74K | $0 | $74K | 100.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER WZ STOP LOSS COALITION | ONE UNIVERSITY SQUARE DRIVE SUITE 100 PRINCETON, NJ 08540 | HCC LIFE INSURANCE COMPANY | $0 | $13K | $13K | 17.10% |
| SPECIAL RISK INSURANCE SERVICES INC3 | PO BOX 1108 VOORHEES, NJ 080434161 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $1K | $0 | $1K | 20.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE EIN 59-1031071 | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan Service code 12 | — | $831K |
| CIGNA | Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation; Direct payment from the plan; Float revenue; Other services Service code 12 | — | $0 |
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 | 1,408 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,408 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 1,082 | $2.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 3,387 | $0 |
| Vision | VISION SERVICE PLAN | 1,311 | $224K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,408 | $659K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,408 | $659K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,408 | $659K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,082 | $74K |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,416 | $703K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,387 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.