| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 2055 GATEWAY PLACE, STE 400 SAN JOSE, CA 95110 | AETNA LIFE INSURANCE CO. | $85K | — | $85K | 4.83% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN INC. | $50K | $1 | $50K | 4.25% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 2055 GATEWAY PLACE SUITE 400 SAN JOSE, CA 95110 | AETNA HEALTH, INC | $15K | — | $15K | 5.08% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 4250 EXECUTIVE SQUARE SUITE 900 LA JOLLA, CA 92037 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $25K | — | $25K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $2K | $12K | 10.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | PO BOX 101162 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN OF COLORADO, INC. | $6K | — | $6K | 5.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | LOCKBOX 100485 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC STATES, INC. | $4K | — | $4K | 6.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $205 | $3K | 7.32% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $123 | $2K | 5.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL | 3000 EXECUTIVE PKWY STE 300 SAN RAMON, CA 94583 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $972 | — | $972 | 3.04% |
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 | 1,136 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 38 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 109 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,283 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | AETNA LIFE INSURANCE CO. | 221 | $3.4M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 316 | $248K |
| Vision | VISION SERVICE PLAN | 228 | $32K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,010 | $112K |
| Short-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,010 | $145K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,010 | $112K |
| Prescription drug(5 contracts, 5 carriers) | AETNA LIFE INSURANCE CO. | 221 | $3.4M |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,010 | $153K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,010 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.