| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC. | PO BOX 28852P NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC | $97K | — | $97K | 3.01% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC. | PO BOX 28852P NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC | $28K | — | $28K | 3.00% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC - OH | 1001 LAKESIDE AVE CLEVELAND, OH 44114 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $10K | — | $10K | 2.13% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $47K | $2K | $49K | 10.48% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 100878852 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $16K | $2K | $18K | 11.41% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | 300 SOUTH GRAND AVE SUITE 2000 LOS ANGELES, CA 90071 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $3K | — | $3K | 2.24% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 100878852 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $13K | $2K | $15K | 11.53% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 10087 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17K | — | $17K | 15.20% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE, INC | 2010 MAIN STREET SUITE 1050 IRVINE, CA 92614 | NATIONAL UNION FIRE INSURANCE CO OF PITTSBURGH, PA | $9K | — | $9K | 15.00% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $93 | $2K | 10.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 NEW YORK, NY 10087 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $652 | $308 | $960 | 7.90% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS SERVICES INC | PO BOX 30398 LOS ANGELES, CA 90030 | HARTFORD LIFE AND ACCIDENT | $2K | — | $2K | 15.00% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $51 | — | $51 | 11.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIW TOWERS WATSON DELAWARE INC. | 300 SOUTH GRAND AVE STE 2000 LOS ANGELES, CA 90071 | HARTFORD LIFE AND ACCIDENT | $22 | — | $22 | — |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | PO BOX 30398 LOS ANGELES, CA 90030 | HARTFORD LIFE AND ACCIDENT | -$481 | — | -$481 | — |
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 | 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)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 439 | $4.8M |
| Dental | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | 84 | $12K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 959 | $466K |
| Short-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,054 | $159K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,054 | $133K |
| Prescription drug(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 439 | $4.8M |
| Other(6 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 959 | $663K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,054 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.