| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | 801 SOUTH FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | KAISER FOUNDATION HEALTH PLAN INC | $39K | $0 | $39K | 2.42% |
| USI INSURANCE SERVICES LLC3 | 150 NORTH MICHIGAN AVENUE SUITE 3900 CHICAGO, IL 60601 | KAISER FOUNDATION HEALTH PLAN INC | $20K | $0 | $20K | 1.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | 2010 MAIN STREET, SUITE 1050 IRVINE, CA 92614 | CALIFORNIA PHYSICIANS SERVICE | $303 | $35K | $35K | 3.13% |
| USI INSURANCE SERVICES LLC3 | 630 WEST GERMANTOWN PIKE, SUITE 200 PLYMOUTH MEETING, PA 19462 | CALIFORNIA PHYSICIANS SERVICE | $209 | $24K | $24K | 2.13% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $9K | $0 | $9K | 5.90% |
| USI INSURANCE SERVICES LLC3 | 777 SOUTH FIGUEROA STREET SUITE 2100 LOS ANGELES, CA 90071 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $6K | $0 | $6K | 4.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | $0 | $6K | 4.13% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $1K | $5K | 3.34% |
| USI INSURANCE SERVICES LLC3 | 777 SOUTH FIGUEROA STREET SUITE 2100 LOS ANGELES, CA 90071 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $0 | $4K | 2.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | 2010 MAIN STREET, SUITE 1050 IRVINE, CA 92614 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $719 | $0 | $719 | 0.51% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $780 | $8K | 24.48% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON AND COMPANY | PO BOX 6030 PASADENA, CA 91102 | METROPOLITAN LIFE INSURANCE COMPANY | $9 | $0 | $9 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 10.68% |
| RONALD CHASE WANGLIN3 | PO BOX 6030 PASADENA, CA 91002 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $314 | $0 | $314 | 2.09% |
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 | 264 | 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) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 234 | $2.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 276 | $154K |
| Vision | CALIFORNIA PHYSICIANS SERVICE | 96 | $1.1M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 325 | $142K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 325 | $142K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 234 | $2.7M |
| Other(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 325 | $190K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 325 | — |
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.