| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC | 2400 E COMMERCIAL BLVD, SUITE 600 FT LAUDERDALE, FL 333084050 | HUMANA | $139K | — | $139K | 4.85% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $64K | — | $64K | 3.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN, INC. | $55K | — | $55K | 3.26% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES, INC | 13965 W CHINDEN BLVD STE 300 BOISE, ID 83713 | VISION SERVICE PLAN | $11K | — | $11K | 1.80% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN, INC. | $19K | — | $19K | 3.38% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $18K | — | $18K | 3.38% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELEWARE INC. -OH | 1001 LAKESIDE AVE CLEVELAND, OH 44114 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $571 | $571 | 0.17% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 3.24% |
| WILLIS TOWERS WATSON US LLC | 300 SOUTH GRAND AVE SUITE 200 LOS ANGELES, CA 90071 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $2K | — | $2K | 1.98% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELEWARE INC. | PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $350 | — | $350 | 3.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MN EIN 41-0984460 NONE | Claims processing; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees Service code 12 | — | $1.5M |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | — | $1.3M |
| RIGHT RX LLC - KEENAN PHARMACY CARE EIN 38-3797947 NONE | Contract Administrator Service code 13 | — | $401K |
| BRIDGE HEALTH EIN 26-0804648 NONE | Contract Administrator Service code 13 | — | $230K |
| MILLIMAN EIN 91-0675641 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $220K |
| HEALTH FITNESS CORP EIN 41-1580506 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $213K |
| SAVEONSP EIN 47-3603390 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $195K |
| DELTA DENTAL EIN 41-1905554 NONE | Contract Administrator Service code 13 | — | $182K |
| EXPRESS SCRIPTS INC. EIN 43-1420563 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $135K |
| WELLNESS CORPORATE SOLUTIONS NONE | Contract Administrator Service code 13 | PO BOX 8034 BURLINGTON, NC 27216 | $131K |
| VIRGIN PULSE NONE | Contract Administrator Service code 13 | 75 FOUNTAIN ST PROVIDENCE, RI 02902 | $127K |
| HEALTH ALLIANCE EIN 37-1260731 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $89K |
| ROC GROUP EIN 36-4220885 NONE | Participant communication; Direct payment from the plan; Consulting (pension) Service code 17 | — | $85K |
| JIFF EIN 32-0327707 NONE | Other services; Direct payment from the plan Service code 49 | — | $75K |
| FAEGRE BAKER DANIELS LLP EIN 41-0244008 NONE | Legal; Direct payment from the plan Service code 29 | — | $64K |
| SELECTACCOUNT EIN 41-6019132 NONE | Contract Administrator; Claims processing Service code 12 | — | $62K |
| PAYFLEX EIN 91-1774434 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $54K |
| EIDE BAILLY LLP EIN 45-0250958 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $48K |
| LIBERTY COMMUNITY CARE NONE | Contract Administrator Service code 13 | PO BOX 175 HOSFORD, FL 32334 | $46K |
| REPCO PRINTERS & LITHOGRAPHERS EIN 43-0864437 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $26K |
| AON HEWITT EIN 36-2237591 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $17K |
| BPC (HEALTH REIMBURSEMENT ACCOUNTS) EIN 36-3036100 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $13K |
| MINNESOTA HEALTH ACTION GROUP EIN 20-2307185 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $11K |
| ADP NATIONAL ACCOUNT SERVICES EIN 22-1467904 NONE | Contract Administrator Service code 13 | — | $10K |
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)(10 contracts, 5 carriers) | HIGHMARK INC. | 351 | $12.7M |
| Dental(3 contracts, 3 carriers) | DELTA DENTAL | 10,821 | $6.5M |
| Vision(3 contracts, 2 carriers) | HUMANA | 4,468 | $3.5M |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 85 | $3K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 85 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 10,821 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.