| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNIVOPS INSURANCE SERVICE3 Filed as: UNIVOPS INSURANCE SERVICES LLC | 1875 SOUTH GRANT ST SUITE 960 SAN MATEO, CA 94402 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $205K | $179K | $384K | 2.19% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA, INC. | CENTRE SQUARE EAST 1500 MARKET ST PHILADELPHIA, PA 19102 | EXCELLUS BLUECROSS BLUESHIELD | $150K | — | $150K | 1.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA, INC. | CENTRE SQUARE EAST 1500 MARKET ST PHILADELPHIA, PA 19102 | UNIVERA HEALTHCARE | $150K | — | $150K | 1.57% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA INC | CENTER SQUARE EAST 1500 MARKET ST PHILADELPHIA, PA 19102 | MVP HEALTH CARE | $257K | — | $257K | 2.76% |
| UNIVOPS INSURANCE SERVICE3 | 1875 S GRANT ST STE 960 SAN MATEO, CA 94402 | LIFE INSURANCE CO OF NORTH AMERICA | $22K | — | $22K | 0.50% |
| UNIVOPS INSURANCE SERVICE3 | 1875 S GRANT ST STE 960 SAN MATEO, CA 94402 | LIFE INSURANCE CO OF NEW YORK | $5K | — | $5K | 0.50% |
| UNIVOPS INSURANCE SERVICE3 | 1875 S GRANT ST STE 960 SAN MATEO, CA 94402 | LIFE INSURANCE CO OF NORTH AMERICA | $418 | — | $418 | 0.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 CLAIMS PROCESSING | Contract Administrator; Other services; Float revenue; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $21.1M |
| SEDGWICK CLAIMS MANAGEMENT EIN 01-6208491 CLAIMS PROCESSING | Other insurance fees and expenses; Contract Administrator; Claims processing Service code 12 | — | $14.8M |
| UNITED HEALTHCARE INS CO OF NY EIN 36-2739571 CLAIMS PROCESSING | Other insurance fees and expenses; Other services; Contract Administrator Service code 13 | — | $5.3M |
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 | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(7 contracts, 7 carriers) | KAISER FOUNDATION HEALTH PLAN INC. (CALIFORNIA) | 6,130 | $70.1M |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 54,922 | $17.5M |
| Long-term disability | LIFE INSURANCE CO OF NORTH AMERICA | 0 | $4.4M |
| Prescription drug(7 contracts, 7 carriers) | KAISER FOUNDATION HEALTH PLAN INC. (CALIFORNIA) | 6,130 | $70.1M |
| Other(3 contracts, 3 carriers) | MAGELLAN BEHAVIORAL HEALTH | 55,335 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 55,335 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.