| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 730054 DALLAS, TX 75373 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $37K | — | $37K | 2.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 11201 N TATUM BLVD #300 PHOENIX, AZ 85028 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15K | — | $15K | 12.11% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 4250 EXECUTIVE SQUARE SUITE 900 LA JOLLA, CA 92037 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $453 | $453 | 0.38% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 16220 N. SCOTTSDALE RD #600 SCOTTSDALE, AZ 85254 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $3K | — | $3K | 5.00% |
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 | 168 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 13 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 88 | $1.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $121K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $121K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $121K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $121K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 130 | $121K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 88 | $1.5M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 191 | $125K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.