| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LBL INSURANCE SERVICES INC3 | 3631 S HARBOR BLVD STE 200 SUITE 200 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN INC | $88K | — | $88K | 0.69% |
| LBL INSURANCE SERVICES INC3 | 3631 S HARBOR BLVD SUITE 200 SANTA ANA, CA 92704 | AETNA LIFE INSURANCE COMPANY | $78K | — | $78K | 0.67% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INS SVCS USA INC | PO BOX 203383 DALLAS, TX 75320 | STANDARD INSURANCE COMPANY | $48K | — | $48K | 1.20% |
| TCS INSURANCE AGENCY INC3 Filed as: TCS INSURANCE AGENCY | 101 LAKESPUR LANDING CIRCLE STE 116 ARKSPUR, CA 94939 | STANDARD INSURANCE COMPANY | $20K | — | $20K | 0.51% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | 335 MADISON AVE FL 20 NEW YORK, NY 10017 | RELIASTAR INSURANCE COMPANY | $55K | — | $55K | 4.58% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON PENNSYLVANIA INC | PO BOX 8500 LOCKBOX 9102 PHILADELPHIA, PA 19178 | RELIASTAR INSURANCE COMPANY | $5K | — | $5K | 0.42% |
| LBL INSURANCE SERVICES INC3 | 3631 S HARBOR BLVD SUITE 200 SANTA ANA, CA 92704 | AETNA INTERNATIONAL | $187 | — | $187 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $1.3M |
| PAYFLEX TPA | Contract Administrator; Account maintenance fees Service code 13 | 10802 FARNAM DRIVE SUITE 100 OMAHA, NE 68154 | $44K |
| TOWERS WATSON OF PENNSYLVANIA INC CONSULTING | Consulting (general); Contract Administrator Service code 13 | 1925 CENTURY PARK EAST SUITE 1500 LOS ANGELES, CA 90067 | $0 |
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 | 4,004 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 31 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 41 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,076 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 3,191 | $24.4M |
| Dental | AETNA LIFE INSURANCE COMPANY | 2,283 | $344K |
| Vision | VISION SERVICE PLAN | 2,820 | $513K |
| Life insurance | STANDARD INSURANCE COMPANY | 4,004 | $4.0M |
| Short-term disability | STANDARD INSURANCE COMPANY | 4,004 | $4.0M |
| Long-term disability | STANDARD INSURANCE COMPANY | 4,004 | $4.0M |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 3,191 | $24.4M |
| Stop-loss / reinsurancereinsurance | RELIASTAR INSURANCE COMPANY | 2,623 | $1.2M |
| Other(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 4,433 | $4.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,433 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.