| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA, INC.-S.F. | 525 MARKET ST, STE 3400 SAN FRANCISCO, CA 94105 | KAISER FOUNDATION HEALTH PLAN, INC. | $49K | — | $49K | 3.55% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | 200 LIBERTY ST FL 6 ONE WORLD FINANCIAL CENTER NEW YORK, NY 10281 | DELTA DENTAL OF CALIFORNIA | $10K | — | $10K | 1.60% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | 1 WORLD FIN CENTER 200 LIBERTY STREET NEW YORK, NY 10281 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $59K | — | $59K | 10.71% |
| IMG5 | 2960 NORTH MERIDIAN STREET INDIANAPOLIS, IN 46208 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $176 | $176 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST, INC | JP MORGAN CHASE, PO BOX 4557 NEW YORK, NY 10249 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $25K | — | $25K | 19.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | ONE WORLD FINANCIAL CTR 200 LIBERTY STREET NEW YORK, NY 10281 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $16K | — | $16K | 20.49% |
| BENEFITSTORE INC3 | 100 BENEFITFOCUS WAY CHARLESTON, SC 29492 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $2K | $2K | 3.07% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | ONE WORLD FINANCIAL CTR 200 LIBERTY STREET NEW YORK, NY 10281 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $13K | — | $13K | 20.60% |
| BENEFITSTORE INC3 | 100 BENEFITFOCUS WAY CHARLESTON, SC 29492 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $2K | $2K | 3.09% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON NORTHEAST INC | ONE WORLD FINANCIAL CTR 200 LIBERTY STREET NEW YORK, NY 10281 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 20.58% |
| BENEFITSTORE INC3 | 100 BENEFITFOCUS WAY CHARLESTON, SC 29492 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $1K | $1K | 3.09% |
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 | 744 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 32 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 786 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 247 | $1.4M |
| Dental | DELTA DENTAL OF CALIFORNIA | 1,482 | $604K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,169 | $132K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 744 | $554K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 744 | $554K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 744 | $554K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 247 | $1.4M |
| Other(4 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 744 | $736K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,482 | — |
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.