| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN INC. | $63K | — | $63K | 4.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | 1918 RIVERSIDE DR LOS ANGELES, CA 90039 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $56K | — | $56K | 9.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $4K | — | $4K | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | — | $3K | 9.80% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | PO BOX 101162 PASADENA, CA 91189 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $20K | — | $20K | 155.30% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC | 200 LIBERTY ST, 7TH FLOOR NEW YORK, NY 10281 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | $3K | — | $3K | 25.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $228 | — | $228 | 10.02% |
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 | 1,194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 56 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 227 | $1.4M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 3 | $33K |
| Vision | VISION SERVICE PLAN | 1,040 | $181K |
| Life insurance(3 contracts, 3 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,238 | $617K |
| Short-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,238 | $602K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,238 | $602K |
| Other(4 contracts, 4 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 1,238 | $629K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,238 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.