| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK INC. | PO BOX 13056 NEWARK, NJ 07188 | RELIASTAR LIFE INSURANCE COMPANY | $29K | — | $29K | 4.00% |
| MERCER HEALTH AND BENEFITS, LLC3 | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | RELIASTAR LIFE INSURANCE COMPANY | $2K | — | $2K | 0.34% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NEW YORK, INC. | ONE WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $308 | — | $308 | 1.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BL. CR. LFE AND HLTH INS. EIN 95-4331852 CONTRACT ADMNSTRTR | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other fees; Other services Service code 12 | — | $4.2M |
| EMPYREAN BENEFIT SOLUTIONS, INC. EIN 20-3029813 CONTRACT ADMNSTRTR | Contract Administrator Service code 13 | — | $421K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACT ADMNSTRTR | Contract Administrator; Claims processing Service code 12 | — | $258K |
| FTBA, INC. EIN 46-4314843 PLAN SPONSOR | Plan Administrator Service code 14 | — | $120K |
| ERNST & YOUNG U.S. LLP EIN 34-6565596 CONSULTANT | Consulting (general) Service code 16 | — | $99K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACT ADMNSTRTR | Contract Administrator Service code 13 | — | $73K |
| MOSS ADAMS LLP EIN 91-0189318 AUDITOR | Accounting (including auditing) Service code 10 | — | $55K |
| MERCER HEALTH & BENEFITS EIN 34-2015463 CONSULTANT | Consulting (general) Service code 16 | — | $39K |
| ORRICK HERRINGTON & SUTCLIFFE LLP EIN 94-2952627 ATTORNEY | Legal Service code 29 | — | $37K |
| AON HEWITT EIN 36-2235791 CONSULTANT | Consulting (general) Service code 16 | — | $20K |
| U.S. BANK NATIONAL ASSOCIATION EIN 31-0841368 TRUSTEE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $8K |
| HAGER STRATEGIC EIN 52-1942556 CONSULTANT | Consulting (general) Service code 16 | — | $7K |
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 | 4,119 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 87 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 134 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,340 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 4,285 | $2.5M |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 3,722 | $731K |
| Other | MAGELLAN HEALTHCARE | 4,285 | $177K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,285 | — |
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.