| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES | PO BOX 100065 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN INC | $65K | — | $65K | 3.99% |
| RUBIN TORREZ3 Filed as: RUBIN TOREZ | 32255 NORTHWESTERN S201 FARMINGTON HILLS, MI 48334 | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | $19K | — | $19K | 1.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MICHIGAN | 32255 NORTHWESTERN S201 FARMINGTON HILLS, MI 48334 | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | — | $2K | $2K | 0.11% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF LA | 801 S FIGUEROA ST, STE 710 LOS ANGELES, CA 90017 | BLUE CROSS AND BLUE SHIELD OF VERMONT | $35K | — | $35K | 2.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | PO BOX 101162 PASADENA, CA 91189 | BLUE CROSS OF CALIFORNIA | $23K | — | $23K | 3.07% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 801 S FIGUEROA ST, STE 700 LOS ANGELES, CA 90017 | AETNA LIFE INSURANCE COMPANY | $36K | — | $36K | 4.71% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 801 S FIGUEROA ST, STE 700 LOS ANGELES, CA 90017 | AETNA INTERNATIONAL | $30K | — | $30K | 5.97% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | — | $1K | $1K | 0.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | 801 S FIGUEROA ST, STE 700 LOS ANGELES, CA 90017 | FOUR EVER LIFE INS CO. | $25K | — | $25K | 5.00% |
| BLUE CROSS BLUE SHIELD OF FLORIDA0 Filed as: BLUE CROSS BLUE SHIELD OF VERMONT | 445 INDUSTRIAL LANE PO BOX 186 MONTPELIER, VT 05601 | FOUR EVER LIFE INS CO. | — | $15K | $15K | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS | 801 S. FIGUEROA STREET, SUITE 700 LOS ANGELES, CA 90017 | BLUE CROSS AND BLUE SHIELD OF MONTANA | $11K | — | $11K | 2.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 801 S FIGUEROA ST LOS ANGELES, CA 90017 | AETNA | $17K | — | $17K | 5.46% |
| ROGERS BENEFIT GROUP INC3 Filed as: ROGERS BENEFIT GRP INC | 5110 N 40TH ST PHOENIX, AZ 85018 | AETNA | $5K | — | $5K | 1.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES | 801 S. FIGUERORA STREET, SUITE 700 LOS ANGELES, CA 90017 | AETNA HEALTH, INC. | $8K | $24K | $32K | 13.59% |
| ACRISURE LLC3 Filed as: FULCRO INSURANCE | PO BOX 9024048 SAN JUAN, PR 00902 | HUMANA INSURANCE OF PUERTO RICO, INC | $4K | — | $4K | 8.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SERVICE OF CA INC | 1 BUSH ST, 9TH FLOOR SAN FRANCISCO, CA 94104 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $1K | — | $1K | 3.98% |
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 | 1,136 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 11 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(18 contracts, 17 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 1,136 | $10.6M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 143 | $1.3M |
| Vision(3 contracts, 3 carriers) | BLUE CROSS AND BLUE SHIELD OF VERMONT | 259 | $2.5M |
| Prescription drug(13 contracts, 12 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 342 | $9.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,136 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.