| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC1 Filed as: WILLIS TOWERS WATSON U.S. LLC | P.O. BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN | $1K | — | $1K | 1.00% |
| WILLIS TOWERS WATSON US LLC1 Filed as: WILLIS TOWERS WATSON U.S. LLC | P.O. BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN | $118 | — | $118 | 0.91% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GROOM LAW GROUP CHARTERED EIN 52-1219029 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $152K |
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $72K |
| WILLIS TOWERS WATSON U.S. LLC EIN 53-0181291 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $43K |
| UMR, INC. EIN 39-1995276 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $40K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3,498 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,498 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN | 393 | $120K |
| Dental | DELTA DENTAL | 19 | $615 |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 2,246 | $548K |
| Prescription drug | EXPRESS SCRIPTS | 393 | $873K |
| Other(2 contracts, 2 carriers) | VIA/EXTEND HEALTH | 1,842 | $84K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,246 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.