| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INS. SVCS | ONE WORLD FINANCIAL CENTER 200 LIBERTY ST NEW YORK, NY 10281 | CALIFORNIA PHYSICIANS' SERVICE | $27K | — | $27K | 3.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK | 1 WORLD FINANCIAL CTR 200 LIBERTY ST, FL. 621 NEW YORK, NY 10281 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | — | $11K | 4.19% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | 200 LIBERTY STREET NEW YORK, NY 10281 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | — | $7K | 5.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INS. SVCS | ONE WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | -$129 | — | -$129 | -4.71% |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 86 | $975K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $136K |
| Vision | CALIFORNIA PHYSICIANS' SERVICE | 86 | $722K |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 109 | $3K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $136K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 86 | $722K |
| Other | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 109 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.