| 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. | $43K | — | $43K | 3.88% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 29754 NETWORK PL CHICAGO, IL 60673 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $24K | — | $24K | 9.19% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 1.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 214 N. TRYON ST. STE 2500 CHARLOTTE, NC 28202 | RELIASTAR LIFE INSURANCE COMPANY | $30K | — | $30K | 11.80% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905643 CHARLOTTE, NC 28290 | RELIASTAR LIFE INSURANCE COMPANY | $28K | — | $28K | 10.87% |
| EMPYREAN INSURANCE SERVICES, INC.3 | 9009 WEST LOOP S. STE 600 HOUSTON, TX 77096 | RELIASTAR LIFE INSURANCE COMPANY | — | $10K | $10K | 4.00% |
| PLANSOURCE BENEFITS ADMINISTRATION3 Filed as: PLANSOURCE BENEFITS ADMINSITRATION | 101 S. GARLAND AVE STE 203 ORLAND, FL 32801 | RELIASTAR LIFE INSURANCE COMPANY | — | $4K | $4K | 1.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | — | $13K | 6.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 1.30% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 29754 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | $4K | — | $4K | 2.09% |
| EMPYREAN INSURANCE SERVICES, INC.3 Filed as: EMPYREAN INSURANCE SERVICES | 3010 BRIARPARK DR STE 8000 HOUSTON, TX 770423706 | VISION SERVICE PLAN | $864 | — | $864 | 0.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PLACE CHICAGO, IL 60673 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 7.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $245 | $245 | 0.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUECROSS BLUE SHIELD OF SOUTH CARO EIN 57-0287419 SERVICE PROVIDER | Claims processing; Contract Administrator Service code 12 | — | $417K |
| EXPRESS SCRIPTS SERVICE PROVIDER | Claims processing; Contract Administrator Service code 12 | 1 EXPRESS WAY ST. LOUIS, MO 63121 | $296K |
| WILLIS TOWERS WATSON SOUTHEAST BROKER | Other commissions Service code 55 | P.O. BOX 31817 CHARLOTTE, NC 28231 | $53K |
| DELTA DENTAL OF MISSOURI EIN 43-0908349 SERVICE PROVIDER | Contract Administrator; Claims processing Service code 12 | — | $49K |
| 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 | 1,413 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,440 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 138 | $1.1M |
| Vision | VISION SERVICE PLAN | 946 | $215K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,419 | $259K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,419 | $224K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,419 | $224K |
| Other(3 contracts, 3 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 1,419 | $289K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,419 | — |
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.