| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST, INC. | 233 SOUTH WACKER DRIVE SUITE 2000 CHICAGO, IL 60606 | HCC LIFE INSURANCE COMPANY | — | $47K | $47K | 4.83% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC. | 200 LIBERTY STREET, FLOOR 3 NEW YORK, NY 10281 | HCC LIFE INSURANCE COMPANY | $34K | — | $34K | 3.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | 38 EASTWOOD DRIVE SUITE 300 SOUTH BURLINGTON, VT 05403 | KAISER FOUNDATION HEALTH PLAN, INC. | $506 | — | $506 | 3.21% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BL. CR. LF AND HLTH INS. CO. EIN 95-4331852 CONTRACT ADMNSTRTR | Float revenue; Contract Administrator; Direct payment from the plan; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.2M |
| EMPYREAN BENEFIT SOLUTIONS, INC. EIN 20-3029813 CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan Service code 13 | — | $214K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $94K |
| BAKER TILLY US, LLP EIN 30-1413443 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $79K |
| FNAI ADMIN SVCS EIN 46-4314843 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $54K |
| HEALTH EQUITY EIN 52-2383166 CONTRACT ADMNSTRTR | Plan Administrator; Direct payment from the plan Service code 14 | — | $52K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $36K |
| HEALTH ADVOCATE CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan Service code 13 | 3043 WALTON ROAD SUITE 150 PLYMOUTH MEETING, PA 19462 | $23K |
| OG LAW EIN 92-3715595 ATTORNEY | Plan Administrator; Direct payment from the plan Service code 14 | — | $16K |
| U.S. BANK NATIONAL ASSOCIATION EIN 31-0841368 TRUSTEE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $10K |
| ALIGHT SOLUTIONS LLC EIN 36-2235791 CONSULTANT | Consulting (general); Direct payment from the plan Service code 16 | — | $8K |
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 | 1,724 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 49 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 58 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,831 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 61 | $874K |
| Prescription drug(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 61 | $873K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,516 | $979K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,516 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.