| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLELLAN AGENCY LLC | LOCKBOX 740659 LOS ANGELES, CA 90074 | KAISER FOUNDATION HEALTH PLAN, INC. | $31K | — | $31K | 1.42% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLELLAN AGENCY LLC | 161 WASHINGTON STREET SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $41K | $6K | $47K | 11.53% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLELLAN AGENCY LLC | 161 WASHINGTON STREET SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $23K | $4K | $27K | 11.57% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLELLAN AGENCY LLC | 161 WASHINGTON STREET SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $15K | $2K | $17K | 11.47% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: MARSH & MCLELLAN AGENCY LLC | 161 WASHINGTON STREET SUITE 1200 CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | $865 | $8K | 11.30% |
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 | 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, INC. | 186 | $2.2M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 944 | $1.1M |
| Vision | VISION SERVICE PLAN | 902 | $147K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 255 | $230K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 174 | $407K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 174 | $150K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 186 | $2.2M |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 255 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 944 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.