| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX 28852, PO BOX 28852 NEW YORK, NY 10087 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $19K | — | $19K | 0.51% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $3K | $3K | 0.08% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $10K | $10K | 1.09% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA, INC. | LOCKBOX #9102, PO BOX 8500 PHILADELPHIA, PA 19178 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $3K | $3K | 0.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX #741909, P.O. BOX 741909 ATLANTA, GA 30374 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | — | $937 | $937 | 0.10% |
| MERCER HEALTH AND BENEFITS, LLC3 | PO BOX 310502 DES MOINES, IA 50331 | HYATT LEGAL PLANS | $15K | — | $15K | — |
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 | 9,781 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 115 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 9,896 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 9,781 | $8.5M |
| Dental | FOUR EVER LIFE INSURANCE CO. | 9,781 | $1.7M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,781 | $3.7M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,781 | $3.7M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 9,785 | $950K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 9,781 | $8.5M |
| Other(5 contracts, 5 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 9,781 | $4.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,785 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.