| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC. | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 100878852 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 2.27% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC. | LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 10087 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $3K | — | $3K | 3.49% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC. | P.O. BOX 741909 LOCKBOX 741909 ATLANTA, GA 303741909 | RELIASTAR LIFE INSURANCE COMPANY | — | $1K | $1K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE & HEALTH INS EIN 95-4331852 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Other services; Claims processing Service code 12 | — | $494K |
| ANGELES INVESTMENT ADVISORS LLC EIN 95-4839031 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $17K |
| HARBOURVEST PARTNERS, LLC EIN 74-3130888 NONE | Investment management fees paid indirectly by plan; Investment management; Investment management fees paid directly by plan Service code 28 | — | $10K |
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 | 293 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 293 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 112 | $541K |
| Stop-loss / reinsurancereinsurance | RELIASTAR LIFE INSURANCE COMPANY | 102 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 112 | — |
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.