| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 NEW YORK, NY 10087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $81K | — | $81K | 2.90% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 NEW YORK, NY 10087 | VISION SERVICE PLAN | $9K | — | $9K | 0.79% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 NEW YORK, NY 10087 | AETNA LIFE INSURANCE COMPANY | $7K | — | $7K | 1.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $7K | — | $7K | 2.35% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | HYATT LEGAL PLANS | $11K | — | $11K | 6.85% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELWARE INC | PO BOX 28852 NEW YORK, NY 10087 | HYATT LEGAL PLANS | $6K | $1K | $7K | 4.15% |
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 | 5,855 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 111 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,966 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(10 contracts, 9 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 9,401 | $9.3M |
| Dental(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 3,247 | $3.7M |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5,920 | $3.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 589 | $313K |
| Prescription drug(9 contracts, 8 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 9,401 | $6.6M |
| Other(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 9,401 | $505K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 9,401 | — |
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.