Plan Ledger DOL Form 5500 · updated monthly

Ds Services of America, Inc. dba Primo Water North Americabenefits

Health and Welfare Plan · TAMPA, FL · plan year 2023

Broker compensation reported · 2023
$190,026

Ds Services of America, Inc. dba Primo Water North America's benefits plan covered 5,962 active participants in 2023, providing health · life · dental · vision · short-term disability · long-term disability · death benefits · other. Insurance brokers and agents were paid $190,026 in commissions and fees, costs that ultimately come out of what the employer and employees pay for coverage. That is $32 per covered person, in the bottom quarter of employer plans that report broker pay.

Insurance contracts · 202315
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES · dentalpremiums n/a · 1,316 covered
METROPOLITAN GENERAL INSURANCE COMPANYpremiums n/a · 580 covered
KAISER FOUNDATION HEALTH PLAN INC. · health hmopremiums n/a · 353 covered
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. · health hmopremiums n/a · 114 covered
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST · health hmopremiums n/a · 61 covered
KAISER FOUNDATION HEALTH PLAN OF COLORADO · health hmopremiums n/a · 19 covered
LINCOLN NATIONAL LIFE INSURANCE COMPANY · ltdpremiums n/a · 5,911 covered
LINCOLN NATIONAL LIFE INSURANCE COMPANY · lifepremiums n/a · 5,342 covered
THE LINCOLN NATIONAL LIFE INSURANCE COMPANYpremiums n/a · 1,229 covered
VISION SERVICE PLAN · visionpremiums n/a · 3,575 covered
KAISER FOUNDATION HEALTH PLAN INC. · health hmopremiums n/a · 941 covered
THE LINCOLN NATIONAL LIFE INSURANCE COMPANYpremiums n/a · 1,005 covered
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON · health hmopremiums n/a · 19 covered
COMPSYCHpremiums n/a · 5,748 covered
Brokers & agents paid · 20233
MERCER HEALTH & BENEFITS, LLC$113,092 · incl $69,327 fees
LOCKTON COMPANIES LLC$1,324 · incl $1,324 fees
Also brokered by Mercer5
7-ELEVEN, Inc TX$4,238,609

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Source: DOL Form 5500 Schedule A, plan year 2023, EIN 205743877 · Verify on EFAST2 · Amounts are as reported by the plan sponsor.