| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC0 | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | FOUR EVER LIFE INS. CO. | $3K | $0 | $3K | 8.00% |
| ANTHEM INSURANCE COMPANIES, INC.0 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 462044903 | FOUR EVER LIFE INS. CO. | $0 | $367 | $367 | 1.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CLAIMS PROCESSOR | Claims processing; Direct payment from the plan Service code 12 | — | $3.7M |
| ALIGHT BENEFITS ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | 100 HALF DAY ROAD LINCOLNSHIRE, IL 60069 | $1.4M |
| MATRIX ABSENCE MANAGEMENT, INC. EIN 77-0493584 CONTRACTOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $381K |
| CROSSOVER HEALTH EIN 27-2210284 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $360K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACTOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $352K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACTOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $136K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 CONTRACTOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $122K |
| WAGEWORKS EIN 20-0198855 CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $98K |
| BNY MELLON CONTRACTOR | Direct payment from the plan; Contract Administrator Service code 13 | 4965 US-42 #1000 LOUISVILLE, KY 40222 | $4K |
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 | 92 | 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) | 92 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 891 | $24.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 0 | $623K |
| Vision | VISION SERVICE PLAN | 10,345 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,345 | — |
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.