| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 300 S GRAND AVE STE 2000 LOS ANGELES, CA 90071 | BLUE CROSS OF CALIFORNIA | $121K | $9K | $129K | 2.49% |
| NAMELY EMPLOYEE BENEFITS, LLC3 Filed as: NAMELY EMPLOYEE BENEFITS LLC | 195 BROADWAY 15TH FL NEW YORK, NY 10007 | BLUE CROSS OF CALIFORNIA | $38 | — | $38 | 0.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 801 S FIGUEROA STREET STE 800 LOS ANGELES, CA 90017 | KAISER FOUNDATION HEALTH PLAN, INC. | $66K | — | $66K | 4.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 2000 SOUTH COLORADO BLVD TOWER II SUITE 900 DENVER, CO 80246 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $111K | — | $111K | 18.06% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 801 SOUTH FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $7K | $750 | $7K | 4.95% |
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 | 729 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 38 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 46 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 813 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 1,045 | $6.7M |
| Dental(4 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,273 | $1.4M |
| Vision(4 contracts, 3 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,273 | $1.4M |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 665 | $616K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 665 | $616K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 665 | $616K |
| Prescription drug(5 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 1,045 | $6.7M |
| Other | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 665 | $616K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,273 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.