| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS HRH | 18101 VON KARMAN AVE, STE 600 IRVINE, CA 92612 | BLUE SHIELD OF CALIFORNIA | $59K | $4K | $63K | 4.25% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | PO BOX 101162 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN INC | $61K | — | $61K | 5.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | PO BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $16K | $1K | $17K | 14.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $1K | — | $1K | 4.44% |
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 | 292 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 309 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 193 | $2.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 0 | $164 |
| Vision | VISION SERVICE PLAN | 283 | $34K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 308 | $116K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 308 | $116K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 308 | $116K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 132 | $1.5M |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 365 | $127K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 365 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.