| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $8K | $8K | 0.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE, INC. | 555 17TH ST STE 2050 DENVER, CO 80202 | SYMETRA LIFE INSURANCE COMPANY | — | $51K | $51K | 3.78% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $5K | $5K | 0.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | PO BOX 18852 LOCKBOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 0.51% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WASTON DELAWARE IN | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 0.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE IN | PO BOX 28852 LOCKBOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $105 | $105 | 0.75% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA BEHAVIORAL HEALTH INC. EIN 41-1648670 EAP ADMIN CONTRACTOR | Contract Administrator; Claims processing; Participant communication; Direct payment from the plan Service code 12 | 11095 VIKING DR STE 350 EDEN PRAIRIE, MN 55344 | $74K |
| ADP EIN 22-3339704 FSA ADMIN CONTRACTOR | Claims processing Service code 12 | 2575 WESTSIDE PKWY STE 500 ALPHARETTA, GA 300046410 | $65K |
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 | 6,808 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 332 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 7,140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(14 contracts, 8 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 7,009 | $22.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 6,362 | $0 |
| Vision | VISION SERVICE PLAN | 5,224 | $649K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 7,140 | $2.7M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,355 | $489K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,682 | $1.1M |
| Prescription drug | CVS PHARMACY, INC. | 4,332 | $0 |
| Stop-loss / reinsurancereinsurance | SYMETRA LIFE INSURANCE COMPANY | 4,342 | $1.4M |
| Other(6 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 7,140 | $3.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,140 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.