| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 525 MARKET STREET, SUITE 3400 SAN FRANCISCO, CA 94105 | SUN LIFE ASSURANCE COMPANY OF CANADA | $43K | — | $43K | 4.04% |
| LOCKTON COMPANIES, LLC3 | 2100 ROSS AVENUE, SUITE 1200 DALLAS, TX 75201 | SUN LIFE ASSURANCE COMPANY OF CANADA | $21K | — | $21K | 2.03% |
| MCINNIS INS & FIN SVCS3 Filed as: MCINNIS, GEORGE D | 5410 SW MACADAM, SUITE 210 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $6K | $302 | $6K | 1.35% |
| LOCKTON COMPANIES, LLC3 | 444 WEST 47TH STREET, SUITE 900 KANSAS CITY, MO 64112 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $2K | — | $2K | 0.36% |
| MCINNIS INS & FIN SVCS3 | 5410 SW MACADAM AVENUE, SUITE 210 PORTLAND, OR 97239 | STANDARD INSURANCE COMPANY | $159 | — | $159 | 10.19% |
| LOCKTON COMPANIES, LLC3 | 500 WEST MONROE STREET, SUITE 3400 CHICAGO, IL 60661 | STANDARD INSURANCE COMPANY | $7 | — | $7 | 0.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 ADMINISTRATOR | Participant communication; Direct payment from the plan; Other services; Non-monetary compensation; Float revenue; Claims processing; Contract Administrator Service code 12 | — | $535K |
| WILLIS OF NEW JERSEY, INC BROKER | Insurance agents and brokers Service code 22 | 150 JFK PARKWAY, SUITE 52 SHORT HILLS, NJ 07078 | $101K |
| LOCKTON COMPANIES, LLC BROKER | Insurance agents and brokers Service code 22 | 444 WEST 47TH ST., 900 KANSAS CITY, MO 64112 | $33K |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 0 | $444K |
| Vision | STANDARD INSURANCE COMPANY | 0 | $2K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 0 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 0 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.