| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | MINNESOTA LIFE INSURANCE COMPANY | $391K | $0 | $391K | 6.05% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | MINNESOTA LIFE INSURANCE COMPANY | $0 | $146K | $146K | 2.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | LOCKBOX #741909 PO BOX 741909 ATLANTA, GA 30374 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $176K | $187K | $363K | 10.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COM LOCKBOX 28852 P.O. BOX 28852 NEW YORK, NY 10087 | MINNESOTA LIFE INSURANCE COMPANY | $0 | $38K | $38K | 2.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: TOWERS WATSON DELAWARE INC. | COM LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | MINNESOTA LIFE INSURANCE COMPANY | $19K | $0 | $19K | 1.11% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELAWARE INC. | LOCKBOX #28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $73K | — | $73K | 8.00% |
| WILLIS TOWERS WATSON US LLC Filed as: TOWERS WATSON DELAWARE INC, | LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $469K | — | $469K | 189.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC. EIN 41-1289245 CLAIMS PROCESSOR-MEDICAL | Claims processing; Other services Service code 12 | PO BOX 1459 MN009-W235 MINNEAPOLIS, MN 55440 | $8.7M |
| KAISER FOUNDATION HEALTH PLAN INC. EIN 94-1340523 CLIMAS PROCESSOR-MEDICAL | Claims processing; Other services Service code 12 | 300 LAKESIDE DRIVE KAISER CENTER - 26TH FLOOR OAKLAND, CA 94612 | $1.3M |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CLAIMS PROCESSOR - DENTAL | Claims processing; Other services Service code 12 | 17871 PARK PLAZA DRIVE SUITE 200 CERRITOS, CA 90703 | $579K |
| ANTHEM BLUE CROSS EIN 95-3760980 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | PO BOX 26016 RICHMOND, VA 23260 | $432K |
| VISION SERVICE PLAN EIN 94-1632821 CLAIMS PROCESSOR - VISION | Claims processing Service code 12 | 3333 QUALITY DRIVE RANCHO CORDOVA, CA 95670 | $157K |
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 | 15,531 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 85 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 15,616 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 70 | $914K |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL OF CALIFORNIA | 18,354 | $18.8M |
| Vision(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 5,338 | $1.3M |
| Life insurance(2 contracts, 2 carriers) | MINNESOTA LIFE INSURANCE COMPANY | 29,002 | $6.7M |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 16,316 | $3.5M |
| Other(4 contracts, 3 carriers) | MINNESOTA LIFE INSURANCE COMPANY | 29,002 | $9.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 29,002 | — |
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.