| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 208546805 | KAISER FOUNDATION HEALTH PLAN, INC. | $62K | — | $62K | 4.87% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 199 SCOTT ST. BUFFALO, NY 14204 | VISION SERVICE PLAN | $10K | — | $10K | 4.60% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 29754 NETWORK PL CHICAGO, IL 606731297 | VISION SERVICE PLAN | $4K | — | $4K | 1.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 31817 CHARLOTTE, NC 28282 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $25K | — | $25K | 19.67% |
| WILLIS TOWERS WATSON US LLC3 | PO BOX 28852 LOCKBOX # 28852 NEW YORK, NY 10087 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | — | $2K | $2K | 1.79% |
| LIAZON BENEFITS INC3 Filed as: LIAZON BENEFITS, INC. | 737 MAIN STREET BUFFALO, NY 14203 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY | $2K | $3K | $5K | 22.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 31817 CHARLOTTE, NC 28231 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $14K | — | $14K | 86.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 31817 CHARLOTTE, NC 28231 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 100.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUE SHIELD OF SOUTH CARO EIN 57-0287419 SERVICE PROVIDER | Claims processing; Contract Administrator Service code 12 | — | $670K |
| EXPRESS SCRIPTS SERVICE PROVIDER | Contract Administrator; Claims processing Service code 12 | 1 EXPRESS WAY ST. LOUIS, MO 63121 | $160K |
| WILLIS TOWERS WATSON SOUTHEAST BROKER | Other commissions Service code 55 | P.O. BOX 31817 CHARLOTTE, NC 28231 | $55K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 SERVICE PROVIDER | Contract Administrator; Claims processing Service code 12 | — | $47K |
| FLORES AND ASSOCIATES EIN 56-1542307 FSA ADMIN | Contract Administrator; Claims processing 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 | 1,428 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 44 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,472 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 213 | $1.3M |
| Vision | VISION SERVICE PLAN | 1,042 | $217K |
| Life insurance(3 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,428 | $61K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,423 | $119K |
| Other(4 contracts, 3 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 1,428 | $196K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,428 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.