| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CALIFORNIA PHYSICIANS' SERVICE | $32 | $134K | $134K | 2.19% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91102 | CALIFORNIA PHYSICIANS' SERVICE | $16 | $88K | $88K | 1.44% |
| MERCER HEALTH AND BENEFITS, LLC3 | 155 N WACKER DRIVE, SUITE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC. | $21K | — | $21K | 1.79% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $14K | $2K | $15K | 1.31% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E FOOTHILL BLVD, SUITE 100 PASADENA, CA 91102 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $22K | $27K | 2.87% |
| MERCER HEALTH AND BENEFITS, LLC3 | ONE INVESTORS WAY NORWOOD, MA 02062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $9K | $9K | $18K | 1.94% |
| MERCER HEALTH AND BENEFITS, LLC3 | 155 N WACKER DRIVE, SUITE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 1.70% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | $340 | $3K | 1.43% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH AND BENEFITS ADMIN | GPO BOX 27447 NEW YORK, NY 10087 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 14.30% |
| RONALD CHASE WANGLIN3 | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $792 | — | $792 | 5.56% |
| POLLOCK LIFE INS CORPORATION3 Filed as: POLLOCK LIFE INSURANCE CORPORATION | 150 PORTOLA ROAD PORTOLA VALLEY, CA 94028 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $327 | $42 | $369 | 7.64% |
| RONALD CHASE WANGLIN3 | P.O. BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.75% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS, INC. | 1125 NW COUCH STREET SUITE 900 PORTLAND, OR 97209 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $33 | $33 | 0.68% |
| POLLOCK LIFE INS CORPORATION3 Filed as: POLLOCK LIFE INSURANCE CORPORATION | 150 PORTOLA ROAD PORTOLA VALLEY, CA 94028 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $162 | $5 | $167 | 5.22% |
| CBA PREMIER INSURANCE SOLUTIONS3 Filed as: CBA PREMIER INSURANCE SOLUTIONS,INC | 2033 GATEWAY PLACE SUITE 500 SAN JOSE, CA 95110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.25% |
| M FINANCIAL HOLDINGS INC3 Filed as: M FINANCIAL HOLDINGS, INC. | 1125 NW COUCH STREET SUITE 900 PORTLAND, OR 97029 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $6 | $6 | 0.19% |
| LEONE, DIRK, THOMAS3 | 2033 GATEWAY PLACE SUITE 500 SAN JOSE, CA 95110 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $183 | — | $183 | 14.99% |
| LEONE, DIRK, THOMAS3 | 2033 GATEWAY PLACE SUITE 500 SAN JOSE, CA 95110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $167 | — | $167 | 15.06% |
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 | 573 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 579 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 984 | $7.5M |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 592 | $960K |
| Vision(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 984 | $6.2M |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 592 | $927K |
| Short-term disability(4 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 592 | $950K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 592 | $927K |
| Prescription drug(3 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 984 | $7.5M |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 592 | $930K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 984 | — |
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.