| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $27K | — | $27K | 2.00% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $491 | $491 | 0.04% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 NEW YORK, NY 10087 | RELIASTAR LIFE INSURANCE COMPANY | $253K | $5K | $258K | 40.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 20854 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | — | $6K | 1.02% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | METLIFE LEGAL PLANS | $9K | $706 | $9K | 10.80% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 20854 | KAISER FOUNDATION HEALTH PLAN, INC. | $567 | — | $567 | 1.02% |
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 | 4,760 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 50 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 147 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,957 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 81 | $640K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,044 | $112K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 7,279 | $374K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 4,756 | $1.3M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,760 | $705K |
| Prescription drug | HAWAII MEDICAL SERVICE ASSOCIATION | 4 | $21K |
| Other(4 contracts, 4 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 4,756 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,279 | — |
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.