| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSHERE CIRCLE CHICAGO, IL 60674 | SUN LIFE ASSURANCE COMPANY OF CANADA | $23K | — | $23K | 8.25% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 38 DISCOVERY, SUITE 250 IRVINE, CA 92618 | VISION SERVICE PLAN | $2K | — | $2K | 2.06% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE AND PRENTICE HODLING COMPANY | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | VISION SERVICE PLAN | $632 | — | $632 | 0.76% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62949 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $122 | $6K | 24.45% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $7 | $2K | 7.73% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 29A TECHNOLOGY DRIVE, SUITE 100 IRVINE, CA 92618 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $253 | — | $253 | 1.32% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 101 WEST MAIN STREET, SUITE 900 NORFOLK, VA 23510 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $128 | — | $128 | 0.67% |
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 | 690 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 19 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 710 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 313 | $1.7M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 501 | $132K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 690 | $281K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 690 | $281K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 313 | $1.7M |
| Other(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 690 | $307K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 690 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.