| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $11K | $0 | $11K | 1.41% |
| MARSH & MCLENNAN AGENCY LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $10K | $0 | $10K | 1.28% |
| WILLIS TOWERS WATSON US LLC3 | — | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $0 | $770 | $770 | 0.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SVCS OF CALIFORNIA | 525 MARKET ST, STE 3400 SAN FRANCISCO, CA 94105 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $6K | $18K | 2.43% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 896620 CHARLOTTE, NC 28289 | KAISER FOUNDATION HEALTH PLAN INC | $10K | $0 | $10K | 1.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SVCS OF CALIFORNIA | 525 MARKET ST, STE 3400 SAN FRANCISCO, CA 94105 | KAISER FOUNDATION HEALTH PLAN INC | $3K | $1K | $4K | 2.36% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 896620 CHARLOTTE, NC 28289 | KAISER FOUNDATION HEALTH PLAN INC | $2K | $0 | $2K | 1.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SVCS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | $5K | $8K | 7.70% |
| MARSH & MCLENNAN AGENCY LLC3 | 161 WASHINGTON STREET CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 0.98% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SVCS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $2K | $4K | 8.63% |
| MARSH & MCLENNAN AGENCY LLC3 | 161 WASHINGTON STREET CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | $0 | $1K | 2.24% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | — | DELTA DENTAL OF CALIFORNIA | $863 | $0 | $863 | 5.19% |
| MARSH & MCLENNAN AGENCY LLC3 | — | DELTA DENTAL OF CALIFORNIA | $811 | $0 | $811 | 4.87% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $996 | $0 | $996 | 10.55% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 350 CONSHOHOCKEN, PA 19428 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $455 | $0 | $455 | 4.82% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $295 | $295 | 3.12% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $716 | $0 | $716 | 10.20% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 350 CONSHOHOCKEN, PA 19428 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $349 | $0 | $349 | 4.97% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $207 | $207 | 2.95% |
| MARSH & MCLENNAN AGENCY LLC3 | — | CIGNA HEALTHCARE OF CALIFORNIA | $3K | $0 | $3K | 48.56% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | — | CIGNA HEALTHCARE OF CALIFORNIA | $25 | $0 | $25 | 0.39% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SVCS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $331 | $236 | $567 | 10.77% |
| MARSH & MCLENNAN AGENCY LLC3 | 161 WASHINGTON STREET CONSHOHOCKEN, PA 19428 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $301 | $0 | $301 | 5.71% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $403 | $0 | $403 | 10.63% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 350 CONSHOHOCKEN, PA 19428 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $185 | $0 | $185 | 4.88% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $0 | $117 | $117 | 3.09% |
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 | 204 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 207 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 111 | $1.7M |
| Dental | DELTA DENTAL OF CALIFORNIA | 70 | $17K |
| Vision | VISION SERVICE PLAN | 158 | $25K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 204 | $107K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 204 | $52K |
| Prescription drug(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 70 | $1.7M |
| Other(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 204 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 204 | — |
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.