| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 4250 EXECUTIVE SQUARE, SUITE 900 LA JOLLA, CA 92037 | UNITED HEALTHCARE INSURANCE COMPANY | $11K | — | $11K | 3.08% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | 444 MARKET ST STE 1600 SAN FRANCISCO, CA 94111 | BLUE CROSS OF CALIFORNIA | $8K | — | $8K | 2.41% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 4250 EXECUTIVE SQ STE 900 LA JOLLA, CA 92037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $241 | $2K | 7.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | PO BOX 101162 PASADENA, CA 911891162 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $116 | $1K | 5.54% |
| ELITE BENEFITS, DIV OF GALLAGH3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $126 | — | $126 | 0.57% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $27 | $27 | 0.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 4250 EXECUTIVE SQ STE 900 LA JOLLA, CA 92037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $214 | $2K | 9.77% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | PO BOX 101162 PASADENA, CA 911891162 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $983 | $82 | $1K | 5.97% |
| ELITE BENEFITS, DIV OF GALLAGH3 | PO BOX 3009 ARLINGTON HEIGHTS, IL 60006 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $164 | — | $164 | 0.92% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $27 | $27 | 0.15% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 911890005 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $280 | $2K | 11.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SERVICES OF CALIFORNIA | PO BOX 101162 PASADENA, CA 911891162 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $955 | $128 | $1K | 12.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $485 | — | $485 | 12.24% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2580 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $69 | $69 | 1.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | TWO PIERCE PLACE, 21ST FL ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $425 | — | $425 | 12.72% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SVCS. INC. | 2850 W GOLF ROAD, 11TH FL ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $38 | $38 | 1.14% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 911891162 | METLIFE LEGAL PLANS | $106 | — | $106 | 17.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON OF CALIFORNIA | 525 MARKET STREET SUITE 3400 SAN FRANCISCO, CA 94105 | METLIFE LEGAL PLANS | — | $8 | $8 | 1.32% |
No Schedule C service providers reported on this filing.
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 124 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 156 | $672K |
| Dental(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 156 | $356K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 143 | $17K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $44K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 17 | $4K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $22K |
| Prescription drug | UNITED HEALTHCARE INSURANCE COMPANY | 77 | $342K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 129 | $44K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.