| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 | 15303 VENTURA BLVD, NO. 700 SHERMAN OAKS, CA 91403 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $45K | — | $45K | 4.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 200 LIBERTY ST NEW YORK, NY 10281 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $22K | — | $22K | 2.38% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | ONE WORLD FINANCIAL CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $111 | — | $111 | 1.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BL. CR. LF AND HLTH INS. CO. EIN 95-4331852 CONTRACT ADMNSTRTR | Float revenue; Claims processing; Other fees; Other services; Contract Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $2.7M |
| EMPYREAN BENEFIT SOLUTIONS, INC. EIN 20-3029813 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $369K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $152K |
| KANTOR AND KANTOR, LLP EIN 20-1049179 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $116K |
| ODA CREATIVE PARTNERS, LTD EIN 36-3518696 CONSULTANT | Participant communication; Direct payment from the plan Service code 38 | — | $95K |
| MOSS ADAMS LLP EIN 91-0189318 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $73K |
| FTBA, INC. EIN 46-4314843 PLAN SPONSOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $59K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $52K |
| PILLSBURY WINTHROP SHAW PITTMAN LP EIN 94-1311126 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $38K |
| HEALTH ADVOCATE CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | 3043 WALTON ROAD, SUITE 150 PLYMOUTH MEETING, PA 19462 | $36K |
| WAGEWORKS, INC. EIN 94-3351864 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $21K |
| POLSINELLI PC EIN 43-1064260 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $21K |
| ALIGHT SOLUTIONS LLC EIN 36-2235791 CONSULTANT | Direct payment from the plan; Consulting (general) Service code 16 | — | $12K |
| U.S. BANK NATIONAL ASSOCIATION EIN 31-0841368 TRUSTEE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $11K |
| OPTUM CONSULTANT | Participant communication; Direct payment from the plan Service code 38 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $8K |
| SONG LAW ATTORNEY | Legal; Direct payment from the plan Service code 29 | 400 KELBY STREET FORT LEE, NJ 07024 | $8K |
| ASSOCIATES INTERNATIONAL, INC. EIN 51-0120338 CONSULTANT | Direct payment from the plan; Participant communication Service code 38 | — | $6K |
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 | 2,891 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 62 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 82 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,035 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 2,634 | $3.2M |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,634 | $925K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,634 | — |
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."
No prospect flags tripped on this filing.