| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WTW INS SVCS WEST INC | PO BOX 101162 PASADENA, CA 911890001 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $83K | — | $83K | 2.10% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $79K | — | $79K | 1.99% |
| SEDGWICK CLAIMS MANAGEMENT SERVICES5 Filed as: SEDGWICK CLAIMS MGMT SERVICES INC. | 2620 THOUSAND OAKS BLVD. MEMPHIS, TN 38118 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $1.5M | $1.5M | 67.16% |
| WILLIS TOWERS WATSON US LLC3 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $68K | — | $68K | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WTW INS SVCS WEST INC | PO BOX 101162 PASADENA, CA 911890001 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $49K | — | $49K | 2.18% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PR BROKERAGE, INC | 500 N AKARDS ST 4300 DALLAS, TX 75201 | TRIPLE S SALUD, INC. | $29K | — | $29K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CHOICE HEALTH PLAN EIN 97-0768835 CONTRACT ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $3.8M |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $2.9M |
| ALIGHT SOLUTIONS LLC EIN 82-1061233 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Direct payment from the plan Service code 15 | — | $2.8M |
| UNITED HEALTH CARE EIN 36-2739571 CONTRACT ADMINISTRATOR | Claims processing; Direct payment from the plan Service code 12 | — | $2.7M |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 CONTRACT ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $2.6M |
| NORTHERN TRUST EIN 36-1561860 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $654K |
| ROC NONE | Direct payment from the plan; Claims processing Service code 12 | 300 E. RANDOLPH ST SUITE 3400 CHICAGO, IL 60601 | $481K |
| WILLIS TOWERS WATSON US LLC NONE | Direct payment from the plan; Actuarial Service code 11 | LOCKBOX 28852, PO BOX 28852 NEW YORK, NY 100878852 | $439K |
| KAISER PERMANENTE EIN 94-1340523 CONTRACT ADMINISTRATOR | Direct payment from the plan; Claims processing Service code 12 | — | $388K |
| KARR BARTH ADMINISTRATORS, INC NONE | Claims processing; Direct payment from the plan Service code 12 | ONE BELMONT AVENUE SUITE 705 BALA CYNWYD, PA 19004 | $323K |
| 2ND MD NONE | Direct payment from the plan; Claims processing Service code 12 | 9655 KATY FWY SUITE 300 HOUSTON, TX 77024 | $226K |
| SPRING CARE, INC. NONE | Direct payment from the plan; Claims processing Service code 12 | 251 PARK AVE SOUTH, 6F NEW YORK, NY 10010 | $159K |
| DOCTOR ON DEMAND, INC NONE | Direct payment from the plan; Claims processing Service code 12 | ONE CALIFORNIA STREET, SUITE 2300 SAN FRANCISCO, CA 94111 | $38K |
| PASSPORT ENTERPRISES LLC NONE | Claims processing; Direct payment from the plan Service code 12 | 300 CENTER DR, SUITE 107 VERNON HILLS, IL 60061 | $28K |
| UNITED BEHAVIORAL HEALTH EIN 94-2649097 CONTRACT ADMINISTRATOR | Direct payment from the plan; Consulting (pension) Service code 17 | — | $18K |
| ERNST & YOUNG EIN 34-6565596 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $14K |
| AON CONSULTING EIN 22-2230064 NONE | Consulting (pension); Direct payment from the plan Service code 17 | — | $11K |
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 | 14,917 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 779 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 15,696 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRIPLE S SALUD, INC. | 92 | $571K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,171 | $4.0M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 7,902 | $2.3M |
| Prescription drug | TRIPLE S SALUD, INC. | 92 | $571K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 8,171 | $4.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,171 | — |
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.