| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | CALIFORNIA PHYSICIANS' SERVICE | $60 | $222K | $222K | 3.58% |
| MERCER HEALTH AND BENEFITS, LLC3 | 155 N WACKER DRIVE, SUITE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC. | $36K | — | $36K | 3.10% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | — | $2K | $2K | 0.14% |
| MERCER HEALTH AND BENEFITS, LLC3 | ONE INVESTORS WAY NORWOOD, MA 02062 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $20K | $18K | $38K | 3.55% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $11K | $1 | $11K | 3.34% |
| MERCER HEALTH AND BENEFITS, LLC3 | 155 N WACKER DRIVE, SUITE 1500 CHICAGO, IL 60606 | KAISER FOUNDATION HEALTH PLAN INC. | $5K | — | $5K | 1.71% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON INSURANCE SERVICES LLC | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $43 | $236 | $279 | 0.10% |
| 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 | 15.77% |
| WANGLIN, RONALD, CHASE3 | PO BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $619 | — | $619 | 5.14% |
| POLLOCK LIFE INS CORPORATION3 Filed as: POLLOCK LIFE INSURANCE CORPORATION | 150 PORTOLA ROAD PORTOLA VALLEY, CA 94028 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $304 | $34 | $338 | 7.00% |
| 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 | — | $27 | $27 | 0.56% |
| WANGLIN, RONALD, CHASE3 | P.O. BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $21 | — | $21 | 0.43% |
| POLLOCK LIFE INS CORPORATION3 Filed as: POLLOCK LIFE INSURANCE CORPORATION | 150 PORTOLA ROAD PORTOLA VALLEY, CA 94028 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $125 | $3 | $128 | 5.19% |
| 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 | $4 | — | $4 | 0.16% |
| 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 | — | $3 | $3 | 0.12% |
| LEONE, DIRK, THOMAS3 | 2033 GATEWAY PLACE SUITE 500 SAN JOSE, CA 95110 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $155 | — | $155 | 15.05% |
| LEONE, DIRK, THOMAS3 | 2033 GATEWAY PLACE SUITE 500 SAN JOSE, CA 95110 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $146 | — | $146 | 15.04% |
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 | 589 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 601 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 953 | $8.0M |
| Dental(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 617 | $1.1M |
| Vision(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 953 | $6.2M |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 617 | $1.1M |
| Short-term disability(4 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 617 | $1.1M |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 617 | $1.1M |
| Prescription drug(4 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 953 | $8.0M |
| Other(3 contracts, 3 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 617 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 953 | — |
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."
No prospect flags tripped on this filing.