| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $70K | — | $70K | 3.52% |
| CALVO'S INSURANCE UNDERWRITERS, INC3 | PO BOX FJ HAGATNA, GU 96932 | TOKIO MARINE PACIFIC INSURANCE LTD. | $18K | — | $18K | 2.00% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | HARTFORD LIFE AND ACCIDENT | $21K | — | $21K | 6.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HUMAN RESOURCE | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | HARTFORD LIFE AND ACCIDENT | — | $6K | $6K | 1.84% |
| AGIS NETWORK INC3 | 2122 KRATKY ROAD ST LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | $2K | $17K | 10.70% |
| MOLENAAR, DAVID A3 | 1188 BISHOP ST, STE 1708 HONOLULU, HI 96813 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | — | $8K | 5.16% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | VISION SERVICE PLAN | $3K | — | $3K | 2.16% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | — | $7K | 16.47% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | USABLE LIFE | $1K | — | $1K | 10.00% |
| MERCER HEALTH AND BENEFITS, LLC3 | 701 MARKET ST STE 1100 SAINT LOUIS, MO 63101 | ZURICH AMERICAN INSURANCE COMPANY | $2K | — | $2K | 25.00% |
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 | 1,533 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,559 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 455 | $3.0M |
| Dental | TOKIO MARINE PACIFIC INSURANCE LTD. | 241 | $896K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 1,387 | $2.1M |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,821 | $342K |
| Short-term disability | USABLE LIFE | 37 | $11K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 777 | $43K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 455 | $2.9M |
| Other(2 contracts, 2 carriers) | EMPLOYEE ASSISTANCE OF THE PACIFIC, LLC | 1,721 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,821 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.