| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COMMISSIONS LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | $385 | — | $385 | 5.18% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CALIFORNIA PHYSICIANS' SERVICE EIN 94-0360524 NONE | Contract Administrator Service code 13 | — | $761K |
| VANGUARD FIDUCIARY TRUST EIN 23-2186884 NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $131K |
| DELTA DENTAL EIN 94-1461312 NONE | Contract Administrator Service code 13 | — | $116K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Contract Administrator Service code 13 | — | $20K |
| THE VITA COMPANIES EIN 94-2595918 NONE | Contract Administrator Service code 13 | — | -$834K |
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 | 3,929 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 665 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,594 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,236 | $10.5M |
| Long-term disability | PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA | 91 | $7K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 1,236 | $9.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,236 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.